Effect of weight reduction on glycated haemoglobin in weight loss trials in patients with type 2 diabetes
Effect of weight reduction on glycated haemoglobin in weight loss trials in patients with type 2 diabetes
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DOI：
10.1111/dom.12971
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发表时间：
2017-09-01
影响因子：
5.8
通讯作者：
Karpefors, Martin
中科院分区：
文献类型：
--
作者：
Gummesson, Anders;Nyman, Elisabeth;Karpefors, Martin
目的根据已发表的针对超重和肥胖的2型糖尿病患者(T2D)的减肥试验数据，在群体水平上量化减肥对糖化血红蛋白(HbA1c)的影响。方法系统地检索MEDLINE、EMBASE和Cochrane Central(1990年1月至2012年12月)的文献，确定在成人、超重和肥胖的T2D患者中进行能量减量饮食、减肥药物或减肥手术的前瞻性试验。根据随访3~24个月的临床资料，建立一个线性模型来描述体重减轻对HbA1c的影响。结果文献检索确定了58篇符合条件的文章，包括124个治疗组和17204名受试者，总共产生了250个数据点，体重和HbA1c的平均水平与基线相比发生了同步变化。基于模型的分析表明，体重减轻和糖化血红蛋白降低之间存在线性关系，总体人口体重每减少1公斤，糖化血红蛋白平均降低0.1个百分点。基线HbA1c是体重减轻和HbA1c之间关系的重要协变量：基线水平高的HbA1c与相同体重减轻程度的HbA1c下降幅度更大相关。收集的试验数据还表明，抗糖尿病药物的减肥依赖减少。结论在组水平，肥胖和超重的T2D患者的体重减轻始终伴随着HbA1c以剂量依赖的方式下降。本研究中开发的模型估计，平均体重每减轻一公斤，糖化血红蛋白平均降低0.1个百分点。血糖控制差的人群比体重减轻程度控制良好的人群的HbA1c降低幅度更大。这一关于减肥对HbA1c影响的先前试验的数据总结可能被用来支持未来旨在证明减肥干预对T2D治疗有效性的研究的设计和解释。
AimTo quantify the effect of weight loss on glycated haemoglobin (HbA1c) at group level, based on data from published weight loss trials in overweight and obese patients with type 2 diabetes (T2D).MethodsA systematic literature search in MEDLINE, EMBASE and Cochrane CENTRAL (January 1990 through December 2012) was conducted to identify prospective trials of energy-reduced diets, obesity drugs or bariatric surgery in adult, overweight and obese patients with T2D. Based on clinical data with follow-up from 3 to 24 months, a linear model was developed to describe the effect of weight reduction on HbA1c.ResultsThe literature search identified 58 eligible articles consisting of 124 treatment groups and 17 204 subjects, yielding a total of 250 data points with concurrent mean changes from baseline in weight and HbA1c. The model-based analyses indicated a linear relationship between weight loss and HbA1c reduction, with an estimated mean HbA1c reduction of 0.1 percentage points for each 1 kg of reduced body weight for the overall population. Baseline HbA1c was a significant covariate for the relationship between weight loss and HbA1c: high HbA1c at baseline was associated with a greater reduction in HbA1c for the same degree of weight loss. The collected trial data also indicated weight-loss-dependent reductions in antidiabetic medication.ConclusionsAt group level, weight loss in obese and overweight patients with T2D was consistently accompanied by HbA1c reduction in a dose-dependent manner. The model developed in the present study estimates that for each kg of mean weight loss, there is a mean HbA1c reduction of 0.1 percentage points. HbA1c-lowering is greater in populations with poor glycaemic control than in well controlled populations with the same degree of weight loss. This summary of data from previous trials regarding the effect of weight reduction on HbA1c may be used to support the design and interpretation of future studies that aim to demonstrate the efficacy of weight loss interventions for T2D treatment.