Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes

被引：1870

作者：

Wing, Rena ^{[1
]}

Bolin, Paula ^{[2
]}

Brancati, Frederick L. ^{[3
]}

Bray, George A. ^{[4
]}

Clark, Jeanne M. ^{[3
]}

Coday, Mace ^{[5
]}

Crow, Richard S. ^{[6
]}

Curtis, Jeffrey M. ^{[1
,7
]}

Egan, Caitlin M. ^{[8
]}

Espeland, Mark A. ^{[9
]}

Evans, Mary ^{[2
]}

Foreyt, John P. ^{[10
]}

Ghazarian, Siran ^{[11
]}

Gregg, Edward W. ^{[12
]}

Harrison, Barbara ^{[2
]}

Hazuda, Helen P. ^{[13
]}

Hill, James O. ^{[14
]}

Horton, Edward S. ^{[15
]}

Hubbard, Van S. ^{[2
]}

Jakicic, John M. ^{[16
]}

Jeffery, Robert W. ^{[17
]}

Johnson, Karen C. ^{[5
]}

Kahn, Steven E. ^{[18
]}

Kitabchi, Abbas E. ^{[5
]}

Knowler, William C. ^{[19
]}

Lewis, Cora E. ^{[20
]}

Maschak-Carey, Barbara J. ^{[21
]}

Montez, Maria G. ^{[13
]}

Murillo, Anne ^{[18
]}

Nathan, David M. ^{[22
]}

Patricio, Jennifer ^{[23
]}

Peters, Anne ^{[11
]}

Pi-Sunyer, Xavier ^{[24
]}

Pownall, Henry ^{[25
]}

Reboussin, David ^{[26
]}

Regensteiner, Judith G. ^{[27
]}

Rickman, Amy D. ^{[28
]}

Ryan, Donna H. ^{[29
]}

Safford, Monika ^{[30
]}

Wadden, Thomas A. ^{[31
]}

Wagenknecht, Lynne E. ^{[32
]}

West, Delia S. ^{[33
]}

Williamson, David F. ^{[34
]}

Yanovski, Susan Z. ^{[35
]}

机构：

[1] Brown Univ, Warren Alpert Med Sch, Weight Control & Diabet Res Ctr, Providence, RI 02903 USA

[2] NIDDK, NIH, Bethesda, MD 20892 USA

[3] Johns Hopkins Sch Med, Baltimore, MD USA

[4] Pennington Biomed Res Ctr, Baton Rouge, LA USA

[5] Univ Tennessee, Ctr Hlth Sci, Dept Prevent Med, Memphis, TN 38163 USA

[6] Univ Minnesota, Div Epidemiol & Community Hlth, Minneapolis, MN USA

[7] NIDDK, NIH, Phoenix, AZ USA

[8] Miriam Hosp, Providence, RI 02906 USA

[9] Wake Forest Univ, Dept Biostat Sci, Sch Med, Winston Salem, NC 27109 USA

[10] Baylor Coll Med, Dept Med, Houston, TX 77030 USA

[11] Roybal Comprehens Hlth Ctr, Los Angeles, CA USA

[12] Ctr Dis Control & Prevent, Atlanta, GA USA

[13] Univ Texas Hlth Sci Ctr San Antonio, Dept Clin Epidemiol, San Antonio, TX 78229 USA

[14] Univ Colorado, Hlth Sci Ctr, Ctr Human Nutr, Aurora, CO USA

[15] Joslin Diabet Ctr, Boston, MA 02215 USA

[16] Univ Pittsburgh, Dept Hlth & Phys Act, Pittsburgh, PA USA

[17] Univ Minnesota, Div Epidemiol & Community Hlth, Minneapolis, MN USA

[18] Univ Washington, Dept Med, Seattle, WA USA

[19] NIDDK, NIH, Southwest Amer Indian Ctr, Phoenix, AZ USA

[20] Univ Alabama Birmingham, Div Prevent Med, Birmingham, AL USA

[21] Univ Penn, Weight & Eating Disorder Program, Philadelphia, PA 19104 USA

[22] Massachusetts Gen Hosp, Boston, MA 02114 USA

[23] St Lukes Roosevelt Hosp, Dept Med, New York, NY 10025 USA

[24] St Lukes Roosevelt Hosp, Dept Med, New York, NY 10025 USA

[25] Baylor Coll Med, Dept Med, Houston, TX 77030 USA

[26] Wake Forest Univ, Sch Med, Dept Biostat Sci, Winston Salem, NC 27109 USA

[27] Univ Colorado, Hlth Sci Ctr, Ctr Womens Hlth Res, Aurora, CO USA

[28] Univ Pittsburgh, Dept Hlth & Phys Act, Pittsburgh, PA USA

[29] Pennington Biomed Res Ctr, Baton Rouge, LA USA

[30] Univ Alabama Birmingham, Div Prevent Med, Birmingham, AL USA

[31] Univ Penn, Weight & Eating Disorder Program, Philadelphia, PA 19104 USA

[32] Wake Forest Univ, Sch Med, Div Publ Hlth Sci, Winston Salem, NC 27109 USA

[33] Univ Arkansas Med Sci, Coll Publ Hlth, Dept Hlth Behav & Hlth Educ, Little Rock, AR 72205 USA

[34] Ctr Dis Control & Prevent, Atlanta, GA USA

[35] NIDDK, NIH, Bethesda, MD USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2013年 / 369卷 / 02期

基金：

美国国家卫生研究院;

关键词：

WEIGHT-LOSS; OBESE ADULTS; MORTALITY; INDIVIDUALS; HEALTH; DIET;

D O I：

10.1056/NEJMoa1212914

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. Methods In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. Results The trial was stopped early on the basis of a futility analysis when the median follow- up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P = 0.51). Conclusions An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes.

引用

页码：145 / 154

页数：10

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