低碳水化合物饮食联合动机性访谈对社区2型糖尿病患者减重和血糖控制效果的随机对照研究

摘要

目的 评价低碳水化合物饮食(LCD)联合动机性访谈(MI)对社区2型糖尿病患者的减重和血糖控制效果.方法 选取北京市朝阳区黑庄户社区患有2型糖尿病超重或肥胖的患者为研究对象.采用均衡随机化分组方式,将132例社区超重或肥胖的2型糖尿病患者分配至干预组与对照组.研究对象纳入时间为2016年11月-2017年1月,随访时间为2017年1月-2017年4月.干预组给予LCD联合MI干预方式,对照组依据《中国2型糖尿病防治指南》给予饮食指导及健康教育.比较两组基线资料以及干预3个月体质量、体质指数(BMI)、腰围、臀围及糖化血红蛋白(HbA1c)等指标的不同.结果 干预组与对照组患者各项基线特征(包括性别、年龄、婚姻状况、文化程度、职业、吸烟情况、慢性病患病情况、用药情况、糖尿病患病情况、是否尝试过减重、减重时间及方法、对减重的渴望程度、未来坚持减重的愿望、收缩压、舒张压、体质量、BMI、腰围、臀围、HbA1c)比较,差异均无统计学意义(P＞0.05).试验3个月后,干预组中对未来坚持减重愿望强烈或非常强烈者所占比例高于对照组(39.1％比17.2％),差异有统计学意义(P=0.006);干预组HbA1c低于对照组[6.2(0.7)％比6.8(0.9)％],差异有统计学意义(P＜0.001).干预组与对照组患者体质量、BMI、腰围、臀围各指标的比较,差异无统计学意义(P＞0.05).结论 与传统健康教育方法相比,LCD联合MI可更有效提升患者未来坚持减重的愿望,降低患者HbA1c水平.%Objective To evaluate the effect of low-carbohydrate diet (LCD) combined with motivational interviewing (MI) for losing weight and controlling fasting blood glucose for overweight and obese type 2 diabetic patients.Methods The enrolled participants were 132 overweight and obese type 2 diabetic residents from Heizhuanghu Community,Chaoyang District,Beijing between November 2016 and January 2017.Using block randomization method,they were allocated into intervention group and control group.During the intervention period from January to April,2017,the intervention group received LCD combined with MI,while the control group received diet guidance and health education based on Guidelines for the Prevention and Control of Type 2 Diabetes in China.The main outcome indicators include weight,BMI,waist and hip circumference and HbA1c level.Results There were no significant differences between intervention group and control group for the baseline characteristics (P＞0.05),including gender,age,marital status,educational attainment,occupation,prevalence of smoking,prevalence of chronic disease,medication,diabetic status,history of weightloss,duration and method for weight loss,level of desire to lose weight,desire to stick to a weight loss program in the future and physical examination data,systolic pressure,diastolic pressure,weight,BMI,waist,hip,HbA1c.At the end of intervention,compared with the control group,the intervention group demonstrated significantly stronger desire to stick to a weight loss program in the future (39.1％vs 17.2％),P=0.006],as well as showed reduced average HbA1o level [6.2 (0.7) ％ vs 6.8 (0.9) ％,P＜0.001].However,there were still no significant differences between the groups for weight,BMI,waist or hip circumference (P＞0.05).Conclusion It is very likely that LCD combined with MI is more effective in improving patients' desire to stick to a weight loss program and controlling the HbA1c leve lin the future.