研究表明改变生活方式项目或可在大规模医疗环境下奏效

改变生活方式的项目，例如糖尿病预防项目（DPP），可降低糖尿病的发病率，然而，在现实生活环境中，对类似项目所能带来的实际益处还知之甚少，因为在更多情况下，参与者是被“建议”参加相关计划（如健康医疗体系），而非自己主动选择参加。

VA（美国退伍军人事务部）是美国最大的综合保健系统，自2005年以来，其MOVE项目（为所有地区的退伍军人控制超重和/或肥胖）已拥有超过400 000名参与者。研究人员对来自VA信息科学和计算基础设施（VINCI）数据库的全国数据资料进行分析。在402 693名参试者中，88%是男性，52%已婚，以及67%为白人。在MOVE项目的第一次随访时，参试者的平均年龄为56.5岁，其中已有37.5%罹患糖尿病（使用糖尿病ICD-9 250.xx分类或服用糖尿病药物）。

在跟踪随访了3年的135 686名参试者中，其BMI平均值由36.3降至35.8（体重减轻1.3%）。与那些较少参加相关活动的退伍军人相比，那些积极并坚持参加相关活动的退伍军人（占总参试者人数的8.7%；在6个月内至少参加8次活动，并且第一次和最后一次活动之间至少间隔129天）3年内体重的下降程度更加显著（-2.7% vs. -1.1%，p<0.001），只比DPP计划的结果稍微低了一些（3年内减轻4%的体重）。

罹患糖尿病的退伍军人比那些未患病的退伍军人更有可能积极参加相关活动（9.6% vs. 7.8%，p<0.01），并在3年内减轻更多体重（-1.7% vs. -0.9%，p<0.01）。在那些最初未患糖尿病的退伍军人中，糖尿病的三年发病率为18.7%。根据基线BMI、年龄和性别校正之后，6个月内每减轻1磅体重与三年里糖尿病风险降低1%相关（OR 0.99，p<0.001）。

结论：VA的MOVE项目表明，有可能在大规模医疗环境中实现改变生活方式的项目，这可作为举国抗击糖尿病的模型策略。未来需要进一步研究以判断这一项目对退伍军人的健康状况和对VA医疗保健制度的影响，并找出如何才能最好地鼓励人们积极参与相关项目。

Lifestyle Change Works in a Large National Healthcare System

Lifestyle change programs such as the Diabetes Prevention Program (DPP) can reduce diabetes incidence but there is less understanding of benefit in real world settings where participation is likely to be “recommended” rather than self-selected - such as healthcare systems. The VA is the largest integrated healthcare system in the US and its MOVE program (Managing Overweight and/or Obesity for Veterans Everywhere) has had over 400 000 participants since 2005. We used national data from the VA Informatics and Computing Infrastructure (VINCI) database for analyses. 402 693 participants were 88% male 52% married and 67% white. At the first MOVE visit mean age was 56.5 years and 37.5% had known diabetes (use of the diabetes ICD-9 250.xx or a diabetes drug). In 135 686 participants with follow-up at 3 years mean BMI decreased from 36.3 to 35.8 (weight loss -1.3%). Compared to those who were less involved the 8.7% of veterans who participated actively - with intense and sustained participation (at least 8 sessions within 6 months and at least 129 days between first and last sessions) - had significantly greater weight loss at 3 years (-2.7% vs. -1.1% p<0.001) only slightly less than in the DPP (4% at 3 years). Veterans with diabetes were more likely to participate actively than veterans without diabetes (9.6% vs. 7.8% p<0.01) and lost more weight at 3 years (-1.7% vs. -0.9% p<0.01). Among veterans without diabetes at baseline three-year incidence of diabetes was 18.7%. Each additional pound lost by MOVE participants at 6 months was associated with a 1% lower likelihood of developing diabetes over 3 years (OR 0.99 p<0.001) adjusting for baseline BMI age and gender.

Conclusions: The VA's MOVE program demonstrates that lifestyle change can be achieved in a large scale healthcare setting - a model strategy for combating diabetes nationally. Further research is needed to determine the impact on veterans' health and the VA health system and how best to encourage active participation.

编辑： 郁婷    来源：丁香园