Intervention Review

Long-term non-pharmacological weight loss interventions for adults with type 2 diabetes mellitus

  1. Susan L Norris1,*,
  2. Xuanping Zhang2,
  3. Alison Avenell3,
  4. Edward Gregg2,
  5. Tamara Brown4,
  6. Christopher H Schmid5,
  7. Joseph Lau6

Editorial Group: Cochrane Metabolic and Endocrine Disorders Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 30 MAY 2004

DOI: 10.1002/14651858.CD004095.pub2

Database Title

Additional Information

How to Cite

Norris SL, Zhang X, Avenell A, Gregg E, Brown T, Schmid CH, Lau J. Long-term non-pharmacological weight loss interventions for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004095. DOI: 10.1002/14651858.CD004095.pub2.

Author Information

  1. 1

    Oregon Health Sciences University, Department of Medical Informatics and Clinical Epidemiology, Portland, Oregon, USA

  2. 2

    Center for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, USA

  3. 3

    University of Aberdeen, Health Services Research Unit, Aberdeen, UK

  4. 4

    University of Teesside, School of Health & Social Care, Centre for Food, Physical Activity and Obesity, Middlesbrough, UK

  5. 5

    Tufts University School of Medicine, Boston, Massachusetts, USA

  6. 6

    Tufts Medical Centre, New England Medical Centre/Tufts Evidence-based Practice Center Institute for Clinical Research and Health Policy Studies, Boston, MA, USA

*Susan L Norris, Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Mail Stop B1CC, Portland, Oregon, 97239, USA. norriss@ohsu.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Most persons with type 2 diabetes are overweight and obesity worsens the metabolic and physiologic abnormalities associated with diabetes.

Objectives

The objective of this review is to assess the effectiveness of lifestyle and behavioral weight loss and weight control interventions for adults with type 2 diabetes.

Search methods

Studies were obtained from computerized searches of multiple electronic bibliographic databases, supplemented with hand searches of selected journals and consultation with experts in obesity research.

Selection criteria

Studies were included if they were published or unpublished randomized controlled trials in any language, and examined weight loss or weight control strategies using one or more dietary, physical activity, or behavioral interventions, with a follow-up interval of at least 12 months.

Data collection and analysis

Effects were combined using a random effects model.

Main results

The 22 studies of weight loss interventions identified had a 4,659 participants and follow-up of 1 to 5 years. The pooled weight loss for any intervention in comparison to usual care among 585 subjects was 1.7 kg (95 % confidence interval [CI] 0.3 to 3.2), or 3.1% of baseline body weight among 517 subjects. Other main comparisons demonstrated non significant results: among 126 persons receiving a physical activity and behavioral intervention, those who also received a very low calorie diet lost 3.0 kg (95% CI -0.5 to 6.4), or 1.6% of baseline body weight, more than persons receiving a low-calorie diet. Among 53 persons receiving identical dietary and behavioral interventions, those receiving more intense physical activity interventions lost 3.9 kg (95% CI -1.9 to 9.7), or 3.6% of baseline body weight, more than those receiving a less intense or no physical activity intervention. Comparison groups often achieved significant weight loss (up to 10.0 kg), minimizing between-group differences. Changes in glycated hemoglobin generally corresponded to changes in weight and were not significant when between-group differences were examined. No data were identified on quality of life and mortality.

Authors' conclusions

Weight loss strategies using dietary, physical activity, or behavioral interventions produced small between-group improvements in weight. These results were minimized by weight loss in the comparison group, however, and examination of individual study arms revealed that multicomponent interventions including very low calorie diets or low calorie diets may hold promise for achieving weight loss in adults with type 2 diabetes.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Long-term non-pharmacological weight loss interventions for adults with type 2 diabetes mellitus

Most persons with type 2 diabetes are overweight, and the health of these persons can be improved with weight loss. Weight loss is very difficult to achieve in the long-term, however, particularly among persons with diabetes. This systematic review of diet, physical activity, and behavioral interventions for weight loss, revealed a decrease in weight of 1.7 kg at one year or more. These results were minimized by weight loss in the comparison group, however. No data were identified on quality of life or mortality.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

第2型糖尿病的成年人之長期非藥物的減重

第2型糖尿病患大多數為過重，而肥胖會使得糖尿病相關的代謝與生理異常更加惡化。

目標

本評論文章的目的是評估生活型態和行為減重的效益以及第2型糖尿病成年人的體重控制介入方式。

搜尋策略

從電腦搜查多個電子書目數據庫，輔以手工進行檢索選定期刊，並且諮詢肥胖研究專家。最後一次進行檢索的日期是2004年5月。

選擇標準

無論是已經發表或尚未發表的任何語言的隨機對照試驗，只要是檢測使用一個或多個飲食、身體活動、或行為介入來達到減重或體重控制的策略，並且繼續追蹤至少12個月以上的研究都被納入。

資料收集與分析

使用隨機效益模型(random effects model)來合併計算效益。

主要結論

在已確認的22個介入減重研究，總共有4659受試者，並且追蹤1至5年。在585位參加者，和一般照顧(usual care)相比，任何一種介入方式參加者的平均體重減輕(pooled weight loss)為1.7公斤(95% CI：0.3至3.2)，若是和研究開始的基準體重相比，有517位參加者減輕3.1%。其他主要比較顯示：結果沒有差異，包括：126位接受身體活動和行為介入，其中接受非常低熱量飲食者體重減輕3.0公斤(95 % CI為−0.5至6.4)，或介入前基準體重的1.6%，超過接受低熱量飲食者。在53位接受相同的飲食和行為介入研究，其中接受強度較高的身體活動者減輕3.9公斤(95 % CI為−1.9至9.7)，或介入前基準體重的3.6%，超過接受強度較低或沒有身體活動者。被比較的對照組常常會達到顯著的體重減輕(高達10.0公斤)，減少和介入組的差異。糖化血色素的變化通常和體重的變化相當，因此兩組比較時並沒有顯著差異。在生活品質和死亡率則沒有數據報告。

作者結論

使用飲食、身體活動或行為介入的減重策略可以產生族群間(betweengroup)些微的體重改善，這個結果會因為對照組的體重也減輕而減少了差距，但是，檢視個別的研究顯示，多方面的介入，包括非常低熱量飲食或低熱量飲食可能是比較有希望減少第2型糖尿病成年人的體重。

翻譯人

本摘要由慈濟醫院傅振宗翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

第2型糖尿病成年人實施生活型態介入方式可減輕一些體重，大多數的第2型糖尿病患體重過重，而減重可以改善這些人的健康。就長時間而言，減重是很難達成，尤其是糖尿病人。這一有關飲食、身體活動和行為介入減重的系統性評論文章，顯示追蹤一年或一年以上可以減少1.7公斤體重，這個結果會因為對照組的體重也減輕而減少差距。在生活品質和死亡率並沒有數據報告。

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