健康素养及运动干预对2型糖尿病患者身体测量指标的影响

Health literacy and exercise-focused interventions on body size in Chinese patients with type 2 diabetes

目的评估健康素养和运动干预对2型糖尿病患者体质指数(BMI)和腰臀比(WHR)的影响。方法从上海市闵行区和长宁区选8个社区,整群随机分为健康素养组、运动组、综合组和对照组,招募800例患者,每组200例。干预组分别接受1年的健康素养和/或运动干预,并在第3、6、12和24个月进行随访,测量身高、体重、腰围和臀围。运用广义估计方程评估干预措施在各时间点对患者体型的影响。结果健康素养组在6、12和24个月时BMI均显著低于基线水平(P<0.05),其超重风险也明显下降,分别为基线时的55%(95%CI:0.36~0.84)、57%(95%CI:0.38~0.85)和59%(95%CI:0.49~0.88),但与对照组相比变化差异无统计学意义。运动组基线时腹型肥胖(WHR≥0.90)的男性患者WHR在3、6、12和24个月时均较基线显著改善,呈线性下降趋势,且与对照组相比差异有统计学意义(P <0.05)。基线时腹型肥胖(WHR≥0.85)的女性患者中,运动组和对照组在前3次随访中WHR较基线明显下降,而综合组仅在3个月时下降0.026 (P=0.005)。结论运动干预可有效降低腹型肥胖糖尿病患者的腰臀比,可在肥胖患者中推广使用,以期改善其预后。

Objective To evaluate the effectiveness of health literacy and exercise interventions on body mass index(BMI) and waist-to-hip circumference ratio(WHR) of type 2 diabetes(T2 DM) patients.Methods In this cluster randomized controlled trial,800 T2 DM patients were recruited from 8 communities in Shanghai,China,and randomized into one control arm and three intervention arms receiving interventions focused on health literacy,exercise or both.1-year intervention and 4-times follow-up surveys were conducted at the 3-,6-,12-and 24-months.Generalized Estimated Equation was used to evaluate the effect of interventions at different time points.Results The health literacy group had significant reductions in BMI at the 6-,12-and 24-months(P <0.05),and the risk of overweight also decreased,with OR(95% CI) being 0.55(0.36-0.84),0.57(0.38-0.85) and 0.59(0.49-0.88),respectively,relative to at baseline.These changes,however,were comparable with that in the control group.Among men with WHR≥0.90,exercise intervention significantly improved WHR compare to the control arm at 3-months and the effect sustained to 24-months.Among women with WHR≥0.85,the exercise and control groups also had significant decreases in WHR at 3,6,and 12 months,and the comprehensive group had an average decrease of 0.025 at 3-months(P=0.005).Conclusion Exercise-focused intervention may reduce WHR among Chinese diabetes patients with abdominal obesity,suggesting that the approach could be recommended in this population.