Lifestyle change and mobility in obese adults with type 2 diabetes.
Lifestyle change and mobility in obese adults with type 2 diabetes.
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DOI：
10.1056/nejmoa1110294
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发表时间：
2012-03-29
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影响因子：
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通讯作者：
Look AHEAD Research Group
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作者：
Rejeski WJ;Ip EH;Bertoni AG;Bray GA;Evans G;Gregg EW;Zhang Q;Look AHEAD Research Group
成年2型糖尿病患者的活动能力通常会随着年龄的增长而增加。密集的生活方式干预可以减轻体重并改善健康，可能会减缓这类患者的活动能力丧失。我们随机将5145名年龄在45岁至74岁之间的患有2型糖尿病的超重或肥胖成年人分配给强化生活方式干预或糖尿病支持和教育计划；5016名参与者提供了数据。我们使用隐马尔可夫模型来描述残疾状态，并使用混合效应顺序Logistic回归来估计功能衰退的概率。主要结果是自我报告的活动受限，每年评估4年。在第4年，生活方式干预组的2514名成年人中，517人(20.6%)有严重残疾，969人(38.5%)行动能力良好；在2502人中，支持组的人数分别为656人(26.2%)和798人(31.9%)。与支持组相比，生活方式干预组失去行动能力的风险相对降低了48%(优势比为0.52；95%可信区间为0.44至0.63；P<；0.001)。体重减轻和体能改善(根据跑步机测试评估)都是这种影响的重要中介因素(P<；两个变量均为0.001)。与生活方式干预相关的不良事件包括第一年肌肉骨骼症状的频率略高。体重减轻和健康状况的改善减缓了患有2型糖尿病的超重成年人活动能力的下降。(由卫生与公众服务部和其他部门资助；ClinicalTrials.gov编号，NCT00017953。)
Adults with type 2 diabetes mellitus often have limitations in mobility that increase with age. An intensive lifestyle intervention that produces weight loss and improves fitness could slow the loss of mobility in such patients. We randomly assigned 5145 overweight or obese adults between the ages of 45 and 74 years with type 2 diabetes to either an intensive lifestyle intervention or a diabetes support-and-education program; 5016 participants contributed data. We used hidden Markov models to characterize disability states and mixed-effects ordinal logistic regression to estimate the probability of functional decline. The primary outcome was self-reported limitation in mobility, with annual assessments for 4 years. At year 4, among 2514 adults in the lifestyle-intervention group, 517 (20.6%) had severe disability and 969 (38.5%) had good mobility; the numbers among 2502 participants in the support group were 656 (26.2%) and 798 (31.9%), respectively. The lifestyle-intervention group had a relative reduction of 48% in the risk of loss of mobility, as compared with the support group (odds ratio, 0.52; 95% confidence interval, 0.44 to 0.63; P<0.001). Both weight loss and improved fitness (as assessed on treadmill testing) were significant mediators of this effect (P<0.001 for both variables). Adverse events that were related to the lifestyle intervention included a slightly higher frequency of musculoskeletal symptoms at year 1. Weight loss and improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT00017953.)