Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension
Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension
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DOI：
10.1111/dom.12874
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发表时间：
2017-05-01
影响因子：
5.8
通讯作者：
Daskalopoulou, Stella S.
中科院分区：
文献类型：
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作者：
Dasgupta, Kaberi;Rosenberg, Ellen;Daskalopoulou, Stella S.
目的：在2型糖尿病和高血压患者中，很少有被证实的策略来增强身体活动和心脏代谢谱。我们检查了医生提供的步数处方和监测的效果。方法：随机分配到活动组的参与者配备计步器并记录步数。在一年的时间里，他们的医生审查了他们的记录，并在每次就诊时提供书面的步数处方。总体目标是在一年内每天增加3000步（个人增长率）。对照组的参与者被建议每天进行30 - 60分钟的体力活动。我们评估了未接受胰岛素治疗的参与者对步数、颈动脉股脉波速度（cfPWV，主要）和其他心脏代谢指标的影响，包括糖尿病患者血红蛋白A1c（以下简称A1c）和稳态模型评估-胰岛素抵抗（HOMA-IR）。结果：共有79%的患者完成了最终评估（275/347，平均年龄60岁，SD 11）。超过66%的参与者患有2型糖尿病，超过90%的参与者患有高血压。与对照组相比，积极组参与者每天的步数净增加了20% （1190;95% CI, 550-1840）。cfPWV的变化尚无定论；与对照组相比，积极组2型糖尿病患者的A1c降低（-0.38%;95% CI, -0.69至-0.06）。与对照组相比，活动组的HOMA-IR也有所下降（即，在所有未接受胰岛素治疗的参与者中进行评估；-0.96;95% CI, -1.72至-0.21）。结论：将医生提供的简单步数处方策略纳入常规临床实践可使步数净增加20%；然而，这低于3000步/天的目标增量。虽然没有观察到对cfPWV的决定性影响，但A1c和胰岛素敏感性均有改善。未来的研究将评估扩大干预以增加影响。
Aims: There are few proven strategies to enhance physical activity and cardiometabolic profiles in patients with type 2 diabetes and hypertension. We examined the effects of physician-delivered step count prescriptions and monitoring.Methods: Participants randomized to the active arm were provided with pedometers and they recorded step counts. Over a 1-year period, their physicians reviewed their records and provided a written step count prescription at each clinic visit. The overall goal was a 3000 steps/day increase over 1 year (individualized rate of increase). Control arm participants were advised to engage in physical activity 30 to 60 min/day. We evaluated effects on step counts, carotid femoral pulse wave velocity (cfPWV, primary) and other cardiometabolic indicators including haemoglobin A1c in diabetes (henceforth abbreviated as A1c) and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) in participants not receiving insulin therapy.Results: A total of 79% completed final evaluations (275/347; mean age, 60 years; SD, 11). Over 66% of participants had type 2 diabetes and over 90% had hypertension. There was a net 20% increase in steps/day in active vs control arm participants (1190; 95% CI, 550-1840). Changes in cfPWV were inconclusive; active vs control arm participants with type 2 diabetes experienced a decrease in A1c (-0.38%; 95% CI, -0.69 to -0.06). HOMA-IR also declined in the active arm vs the control arm (ie, assessed in all participants not treated with insulin; -0.96; 95% CI, -1.72 to -0.21).Conclusions: A simple physician-delivered step count prescription strategy incorporated into routine clinical practice led to a net 20% increase in step counts; however, this was below the 3000 steps/day targeted increment. While conclusive effects on cfPWV were not observed, there were improvements in both A1c and insulin sensitivity. Future studies will evaluate an amplified intervention to increase impact.