Treating Type 2 Diabetes by Reducing Postprandial Glucose Elevations: A Paradigm Shift in Lifestyle Modification

背景：2型糖尿病（T2 D）在美国是一种日益增长的流行病，具有破坏性的并发症， 导致重大的健康和个人成本。为了解决这个问题，美国糖尿病协会建议， 一种生活方式计划，重点是通过限制热量和锻炼作为初始或辅助来减肥 从治疗到药物干预。然而，它的普遍适用性是有限的，因为一些 患有T2 D的个体不需要减肥，不想减肥，不能减肥，或不能减肥。 在一生中保持体重减轻。最近的研究表明，代谢不良的主要原因是 对照是餐后血糖（PPG）升高。我们开发了一种治疗方案， 降低PPG而不需要减肥。这种生活方式计划是全面的，综合的，高效的。 超过5个会议，该计划使个人能够使用食物，运动和监测的Glycoprotein负荷 葡萄糖（GEM），以系统的方式。GEM的HbA 1c降低1.03%优于两者 常规减肥（42次Look AHEAD治疗后减少0.64%）和持续使用一线药物 药物治疗（使用二甲双胍减少0.9%）。当通过以下方法提高葡萄糖反馈的数量和质量时， 持续葡萄糖监测（CGM），GEM使HbA 1c降低1.30%。 目的：该项目将确定如何创业板相比，传统的减肥在短期和长期- 2型糖尿病患者的长期随访。与此同时，我们将测试一个 一个概念模型的基础上审查的文献假设，GEM的影响调制的 葡萄糖反馈的质量和数量。这对长期维护具有重要意义;因为 模型提出了一个级联，其中增加葡萄糖反馈的数量或质量可以改善 通过积极和消极的葡萄糖后果立即改变行为。这些意外情况可能 导致改善PPG和胰岛素敏感性，进而改善代谢控制。该级联可 产生有助于保持长期成功的附带利益，例如，更大的授权和更少的 抑郁症状 方法：200名控制不良的T2 D受试者将被随机分配到4组中的1组， 关注餐后血糖以及血糖反馈的质量和数量。短期和长期 将使用基线时获得的医学、行为和心理指标评估获益，3 干预后3个月和干预后12个月。 影响：如果GEM被证明是有效和持久的，它将提供一个替代传统的 以减肥为重点的生活方式改变。GEM具有改善代谢控制，增加自我调节， 依赖性和缓慢的疾病进展。由于GEM是基于手动的，因此易于部署， 它有可能影响很大一部分患有T2 D的成年人。

BACKGROUND: Type 2 diabetes (T2D) is a growing epidemic in the U.S. with devastating complications that result in major health and personal costs. To address this, the American Diabetes Association recommends a lifestyle program that focuses on weight loss through caloric restriction and exercise as an initial or an adjunct treatment to pharmacological interventions. However, its general applicability is limited because some individuals with T2D do not need to lose weight, do not want to lose weight, cannot lose weight, or cannot maintain weight loss over a lifetime. Recent research indicates that a major contributor to poor metabolic control is postprandial glucose (PPG) elevation. We have developed a treatment option that focuses on reducing PPG without requiring weight loss. This lifestyle program is comprehensive, integrated, and efficient. Over 5 sessions, this program empowers individuals to use Glycemic load of food, Exercise, and Monitoring glucose (GEM) in a systematic manner. GEM's 1.03% HbA1c reduction compared favorably to both conventional weight loss (0.64% reduction with 42 sessions of Look AHEAD) and continual use of a first line medication (0.9% reduction with Metformin). When enhancing the quantity and quality of glucose feedback with Continuous Glucose Monitoring (CGM), GEM reduced HbA1c by 1.30%. AIMS: This project will determine how GEM compares to conventional weight reduction at short- and long- term follow-up in a large, representative sample of adults with type 2 diabetes. At the same time, we will test a conceptual model based on a review of the literature postulating that the effects of GEM are modulated by the quality and quantity of glucose feedback. This has important implications for long-term maintenance; since the model proposes a cascade in which increasing either the quantity or quality of glucose feedback improves immediate behavior change through positive and negative glucose consequences. These contingencies may lead to improved PPG and insulin sensitivity, and in turn, improved metabolic control. This cascade may produce ancillary benefits that could help maintain long-term success, e.g. greater empowerment and fewer depressive symptoms. APPROACH: 200 participants with poorly controlled T2D will be randomized to 1 of 4 groups that manipulate both the focus on postprandial glucose and the quality and quantity of glucose feedback. Short- and long-term benefits will be assessed using medical, behavioral and psychological measures obtained at baseline, 3 months post-intervention and 12 months post-intervention. IMPACT: If GEM is shown to be effective and enduring, it will provide an alternative to the conventional weight-loss focused lifestyle modification. GEM has the potential to improve metabolic control, increase self- reliance, and slow disease progression. Because GEM is manual-based, it will be easy to deploy and will give it the potential to impact a large proportion of the adults with T2D.