Are behavioural approaches feasible and effective in the treatment of type 2 diabetes? A propensity score analysis vs. prescriptive diet
Are behavioural approaches feasible and effective in the treatment of type 2 diabetes? A propensity score analysis vs. prescriptive diet
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DOI：
10.1016/j.numecd.2008.06.004
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发表时间：
2009-06-01
影响因子：
3.9
通讯作者：
Marchesini, G.
中科院分区：
文献类型：
--
作者：
Forlani, G.;Lorusso, C.;Marchesini, G.
背景和目标：生活方式的改变被认为是2型糖尿病的首选治疗方法，但在糖尿病单位的“真实的世界”中可获得的数据很少。我们的目的是测量中等和高强度干预对减肥，代谢控制和胰岛素使用的有效性。我们报告了一项前瞻性队列研究，在822例连续2型糖尿病患者中进行，首次在一家专科医院的糖尿病病房进行，为期4年。受试者接受单一处方饮食（饮食）治疗，或接受额外的短期初级营养教育（4组会议-ENE）或强化认知行为疗法（12-15组会议-CBT）。根据分配不同治疗的倾向评分对结果进行调整，该倾向评分来自基于年龄、性别、BMI、HbA 1c、糖尿病病程和基线胰岛素使用的logistic回归。主要结果测量为体重下降和维持体重下降、代谢控制和继发性胰岛素使用失败，两种结构化方案均产生更大的体重下降，并且达到7%体重下降目标的调整概率增加。同样，无论是否使用胰岛素，这两个方案都有利于代谢控制。调整倾向评分后，ENE（风险比，0.48; 95% CI，0.27-0.84）和CBT（风险比，0.36; 95%CI，0.16-0.83）与de nova胰岛素治疗的风险降低相关。旨在改变生活方式的结构化行为方案在“真实的世界”中是可行和有效的设立糖尿病科治疗2型糖尿病。(C)2008 Elsevier B. V.保留所有权利。
Background and aims: Lifestyle changes are considered first tine treatment in type 2 diabetes, but very few data are available in the "real world" of diabetes units. We aimed to measure the effectiveness of moderate and high intensity interventions on weight toss, metabolic control and insulin use. We report a prospective cohort study, carried out in 822 consecutive subjects with type 2 diabetes, first seen in a 4-year period in a diabetes unit of an academy hospital.Methods and results: Subjects were treated with either a sole prescriptive diet (Diet), or received an additional short-course Elementary Nutritional Education (4 group sessions-ENE) or an intensive Cognitive Behavioural Therapy (12-15 group sessions-CBT). The results were adjusted for the propensity score to be assigned different treatments, derived from logistic regression on the basis of age, gender, BMI, HbA1c, diabetes duration and insulin use at baseline. Main outcome measures were weight toss and weight loss maintenance, metabolic control, and secondary failure to insulin use.Both structured programmes produced a larger weight loss, and the adjusted probability of achieving the 7% weight loss target was increased. Similarly, both programmes favoured metabolic control, irrespective of insulin use. After adjustment for propensity score, both ENE (hazard ratio, 0.48; 95% CI, 0.27-0.84) and CBT (hazard ratio, 0.36; 95% CI, 0.16-0.83) were associated with a reduced risk of de nova insulin treatment.Conclusion: Structured behavioural programmes aimed at lifestyle changes are feasible and effective in the "real world" setting of a diabetes unit for the treatment of type 2 diabetes. (C) 2008 Elsevier B.V. All rights reserved.