节食减重10-15 kg,成功逆转2型糖尿病,《柳叶刀》发布里程碑成果!
2017/12/07
“用200卡路里的液体饮食,我打败了2型糖尿病”——这是英国BBC网站12月5日报道一则令人振奋的故事,也是顶级医学期刊《柳叶刀》(The Lancet)最新发布的一项糖尿病里程碑成果:患者通过节食减重,成功逆转了2型糖尿病。


图片来源:BBC

研究中,为了达到减重的目的,参与者花了长达5个月的时间来吃低卡路里的汤和奶昔(soups and shakes)。最终,在这项名为The Diabetes Remission Clinical Trial(DiRECT)的试验中,有近一半的患者成功逆转了2型糖尿病。

65岁的Isobel Murray便是其中一员。她在这一试验中减重超过25千克,现在已经不再需要糖尿病药物。“我终于找回了自己的生活。现在,我根本不认为自己是一名糖尿病患者。” Isobel感慨道。


Isobel Murray no longer thinks of herself as diabetic(图片来源:BC/JAMES GALLAGHER)

事实上,在参与该试验之前,Isobel女士的血糖水平一直非常高,每次去看医生,都会被告知要增加她的药物。

在加入这项试验后,她坚持了为期17周的全液体饮食(all-liquid diet)。具体来说,每天吃4顿液体餐(liquid meal,将一小袋粉末放入水中搅拌,制成汤或奶昔)。这种液体餐包含约200千卡,但也具有正确的营养平衡。在坚持液体饮食一段时间后,一旦体重减轻,饮食学专家就会帮助患者加入健康的固体饮食(solid meal)。

Isobel在接受BBC采访时表示,这是相对容易的,因为,你不必考虑吃什么。


图片来源:The Lancet

研究结果

具体来说,Isobel女士参加的这项试验在2014年7月至2017年8月期间,共招募了306位参与者。他们的年龄在20岁到65岁之间,患糖尿病时间最长的是6年。

研究证实,2型糖尿病的缓解在那些减掉更多体重的参与者中更加普遍,具体数据如下:

——体重增加组:0%的人获得缓解(0/76 participants)

——体重减轻0-5 kg组:7%的人获得缓解(6/89 participants)

——体重减轻5-10 kg组:34%的人获得缓解(19/56 participants)

——体重减轻10-15kg组:57%的人获得缓解(16/28 participants)

——体重减轻超过15 kg组:86%的人获得缓解(31/36 participants)


图片来源:网络

作用机理

那么,为什么体重减轻能逆转糖尿病呢?

原来,胰腺周围堆积的脂肪会给器官中控制血糖水平的β细胞带来压力,使它们停止生产足够的胰岛素,从而导致血糖水平失控。简单来说,通过调整饮食减掉脂肪后,胰腺会恢复正常工作。

论文的第一作者Mike Lean教授说:“现在,我们有了明确的证据表明,减重10-15 kg足以逆转2型糖尿病。这是非常令人兴奋的结果。”

同行评论

在同期发表的一篇评论文章中,东芬兰大学的Matti Uusitupa博士称,这项成果是“令人印象深刻”。他强烈支持“2型糖尿病与体内脂肪量过高密切相关”这一观点,并建议,基于这些新发现,减肥应该成为2型糖尿病治疗中最优先考虑的事情。

他这样写道:目前2型糖尿病的治疗方法主要是根据不同的算法来选择抗糖尿病药物和胰岛素,在严重肥胖的患者中,如果可行,会选择减肥手术来治疗。基于DiRECT的研究结果,我认为,非药理学的方法或许应该被“恢复”了non-pharmacological approach should be revived)。


图片来源:网络

意义重大

论文的通讯作者、英国纽卡斯尔大学的Roy Taylor教授在接受采访时表示:“这是一个真正的‘分水岭’。之前,很多医生和专家认为,2型糖尿病是不可逆转的。一些医生也不认为患者糖尿病得到缓解(remission of diabetes)就是治愈,因为,如果体重回升,糖尿病就复发。然而,到目前为止,Isobel女士已经保持了两年的体重。

总结来说,这项研究证实了,通过体重管理来实现2型糖尿病缓解的可能性。名为Diabetes UK的英国慈善机构认为,该试验是一项里程碑,可能会帮助到无数的糖尿病患者。

论文的作者们认为,他们的研究结果为通过“节食减重”这种干预手段来实现2型糖尿病缓解铺平了道路。此外,值得一提的是,为了调查这种干预手段的长期影响,这项试验仍在进行中。

参考资料:

'I beat type 2 diabetes with 200-calorie drinks'

Weight Management May Reverse T2D

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  • Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial

    Background Type 2 diabetes is a chronic disorder that requires lifelong treatment. We aimed to assess whether intensive weight management within routine primary care would achieve remission of type 2 diabetes. Methods We did this open-label, cluster-randomised trial (DiRECT) at 49 primary care practices in Scotland and the Tyneside region of England. Practices were randomly assigned (1:1), via a computer-generated list, to provide either a weight management programme (intervention) or best-practice care by guidelines (control), with stratification for study site (Tyneside or Scotland) and practice list size (>5700 or ≤5700). Participants, carers, and research assistants who collected outcome data were aware of group allocation; however, allocation was concealed from the study statistician. We recruited individuals aged 20–65 years who had been diagnosed with type 2 diabetes within the past 6 years, had a body-mass index of 27–45 kg/m2, and were not receiving insulin. The intervention comprised withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825–853 kcal/day formula diet for 3–5 months), stepped food reintroduction (2–8 weeks), and structured support for long-term weight loss maintenance. Co-primary outcomes were weight loss of 15 kg or more, and remission of diabetes, defined as glycated haemoglobin (HbA1c) of less than 6·5% (<48 mmol/mol) after at least 2 months off all antidiabetic medications, from baseline to 12 months. These outcomes were analysed hierarchically. This trial is registered with the ISRCTN registry, number 03267836. Findings Between July 25, 2014, and Aug 5, 2017, we recruited 306 individuals from 49 intervention (n=23) and control (n=26) general practices; 149 participants per group comprised the intention-to-treat population. At 12 months, we recorded weight loss of 15 kg or more in 36 (24%) participants in the intervention group and no participants in the control group (p<0·0001). Diabetes remission was achieved in 68 (46%) participants in the intervention group and six (4%) participants in the control group (odds ratio 19·7, 95% CI 7·8–49·8; p<0·0001). Remission varied with weight loss in the whole study population, with achievement in none of 76 participants who gained weight, six (7%) of 89 participants who maintained 0–5 kg weight loss, 19 (34%) of 56 participants with 5–10 kg loss, 16 (57%) of 28 participants with 10–15 kg loss, and 31 (86%) of 36 participants who lost 15 kg or more. Mean bodyweight fell by 10·0 kg (SD 8·0) in the intervention group and 1·0 kg (3·7) in the control group (adjusted difference −8·8 kg, 95% CI −10·3 to −7·3; p<0·0001). Quality of life, as measured by the EuroQol 5 Dimensions visual analogue scale, improved by 7·2 points (SD 21·3) in the intervention group, and decreased by 2·9 points (15·5) in the control group (adjusted difference 6·4 points, 95% CI 2·5–10·3; p=0·0012). Nine serious adverse events were reported by seven (4%) of 157 participants in the intervention group and two were reported by two (1%) participants in the control group. Two serious adverse events (biliary colic and abdominal pain), occurring in the same participant, were deemed potentially related to the intervention. No serious adverse events led to withdrawal from the study. Interpretation Our findings show that, at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs. Remission of type 2 diabetes is a practical target for primary care.

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