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[ADA2012]糖尿病前期的药物治疗:生活方式改变及二甲双胍足够了吗?YES
——科罗拉多大学医学院预防医学和生物统计学系Richard F.Hamman教授访谈
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作者:R.F.Hamman 2012/6/13 16:38:00    加入收藏
内容概要:Hamman教授: 生活方式干预对于糖尿病的预防作用主要发生在干预的前3年,这种获益可以持续10年时间。但是糖尿病总数仍然在增多,生活方式干预并不能完全预防糖尿病,而只是延缓其发生。二甲双胍对于糖尿病具有中等程度的预防作用,长期应用二甲双胍,糖尿病的发生风险仅有轻微降低。

  <International Diabetes>: In your presentation you gave two statistics: a 34% decrease in diabetes incidence with lifestyle and an 18% decrease in diabetes with metformin over ten years on the Diabetes Prevention Program (DPP) study. Can you comment on that?
  Prof. Hamman:  Basically the largest effect of the prevention intervention for lifestyle occurred in the first three years and that was then maintained over ten years. There was still an increase in diabetes. It didn’t completely prevent it; it delayed it. Metformin achieved an intermediate amount of prevention and then people continued to take metformin and that risk, if anything, declined a little bit from what it was. The difference with placebo was smaller than what we might have expected but still very substantial – a 30% reduction over ten years in people who in the lifestyle group had taken the intervention basically for only three years but then with very limited follow-up and reinforcement. We did try to reinforce it but people continued gaining weight but it was still an effective intervention. That is the good part.

  《国际糖尿病》: 您在演讲中提到两组数据:糖尿病预防计划(DPP)研究10年的随访观察发现,生活方式干预使糖尿病发生率降低34%,二甲双胍治疗可使糖尿病发生率降低18% 。您对此有何评论?
  Hamman教授: 生活方式干预对于糖尿病的预防作用主要发生在干预的前3年,这种获益可以持续10年时间。但是糖尿病总数仍然在增多,生活方式干预并不能完全预防糖尿病,而只是延缓其发生。二甲双胍对于糖尿病具有中等程度的预防作用,长期应用二甲双胍,糖尿病的发生风险仅有轻微降低。与安慰剂比较,生活方式干预对糖尿病的预防作用尽管低于预期,但仍然非常显著(仅仅在前3年开展了生活方式干预,此后的随访观察和强化措施非常有限,10年后的糖尿病发生率仍然降低了30%)。尽管努力开展强化干预,受试者的体重仍出现了持续增加,但尽管如此,干预措施仍然是有效的。

  <International Diabetes>:What does this say about our lifestyle interventions? Do we need to continue them on for a long time or is it enough to do it for a limited period?
  Prof. Hamman: There are a range of opinions. It is clear that the longer you keep the weight loss going and the more you lose, the better you do. However, it appears, from limited data from Finland and from us, that a time-limited intervention of two to three years actually confers long-term benefits. In China, the Da Qing study did a relatively limited lifestyle intervention that had twenty years of impact and reduced diabetes in China by 43% compared to the group who didn’t get intervention. That intervention stopped after two or three years. That’s a twenty year impact with a two or three year intervention.

  《国际糖尿病》: 我们应当如何选择生活方式干预策略呢?应当进行长期持续的干预还是仅需要在一段时间内进行干预就足够了?

  Hamman教授: 这个问题还存在不同的观点。很显然,保持体重减轻的时间越长,体重减轻越多越好。但从芬兰和我们所得到的有限的研究数据来看,有限的2年到3年的干预就足以保证受试者长期获益。中国的大庆研究中,有限时间内的生活干预对糖尿病的影响一直延续到了20年后,与非干预组比较,糖尿病发生率降低了43%。而这项研究中,干预措施仅持续了2年到3年,却对20年后的糖尿病发生率产生了影响。

  <International Diabetes>:When you were talking about the criteria for an intervention and whether or not it is effective in the real world, my thoughts were that regardless what intervention you do, they regain the weight but maybe that is not so important?
  Prof. Hamman: I am sure there is something going on with weight regain that isn’t good for the underlying physiology but it appears (and I don’t think we have the final answer) that some real weight loss for some period of time does do some resetting of the various physiological processes, not completely and not forever, but it does do some resetting so that at a time when people do regain weight, they are still better off. Why exactly that is I don’t think anybody knows. With better medications and with better adherence to lifestyle, we would do an even better job.

  《国际糖尿病》: 您刚才提到了干预措施的标准以及在真实世界中是否有效等问题,我想不管选择哪种干预策略,受试者都会重新增重,但这可能这并不重要,是这样吗?
  Hamman教授:我确信,重新增重会使机体产生一些负面的生理学变化,但目前看来(我认为现在还不能下结论),一段时间的体重实际降低确实可以对多种生理过程进行重新设定,这种设定不是彻底的和永久的,但由于存在这种一段时间内的重新设定,即使在今后体重重新增加,受试者仍然可以获益。我想可能没有人知道其中的确切机制。但好的治疗药物结合好的生活方式干预依从性,糖尿病的预防将会取得新的进步。



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 延伸阅读
网站用户: 徐方 时间:2013/3/16 22:19:27
对于糖尿病前期生活干预效果确实显著,我的母亲与我的二姨几乎是同时患的糖尿病(时间1976年),我母亲患病时因国内开没有开展糖尿病防治教育,用药也只是降糖灵、消渴丸,不知道有胰岛素,也不知定期检查,患病17年后因并发心力衰竭逝世,年仅62岁。但是我的二姨在大庆工作参加了生活干预对糖尿病的研究组教育,她至今还生存,享年84岁。这就证明了预防教育、生活干预的重要性,我也认为进行糖尿病防治教育可以让没有的糖尿病的人远离糖尿病,让糖尿病人远离并发症,知识改变糖尿病,自我管理改变命运。

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