摘要
背景：与生活方式相关的因素是 2 型糖尿病发病和发展的基本要素，这一点已得到研究。然而，行为因素在临床实践中很容易被忽视。本研究调查了生活方式的改变是否与新诊断的2型糖尿病患者的糖尿病缓解相关：我们利用韩国国民健康保险服务机构（KNHIS）的健康检查队列招募了 2009 年至 2012 年新发 2 型糖尿病患者。停药后在体检中至少有一次空腹血糖水平低于 126 mg/dL，即为缓解。我们采用自填式问卷调查患者的生活方式。我们调查了开始服用糖尿病药物前后的吸烟、饮酒和定期运动情况，并通过对缓解情况进行逻辑回归的几率比（ORs）来评估两者之间的关联：共分析了 138,211 名在 2009 年至 2012 年期间确诊的 2 型糖尿病患者，其中 8,192 人（6.3%）在截至 2017 年的随访期间报告病情缓解。在未缓解组中，开始服用糖尿病药物前测量的基线空腹血糖水平明显更高（180 mg/dL vs. 159 mg/dL，P < 0.001）。此外，未缓解组使用联合口服降糖药治疗的比例更高（15% vs. 8%，P < 0.001）。持续吸烟和饮酒与病情缓解呈负相关（OR，0.72；95% 置信区间[CI]，分别为 0.67-0.77 和 OR，0.90；95% CI，0.84-0.95），而开始定期锻炼与病情缓解呈正相关（OR，1.54；95% CI，0.46-1.63）。戒酒增加了男性患者病情缓解的可能性（OR，1.20；95% CI，1.10-1.32）。与吸烟史或戒烟的关系并不明确，但新的吸烟行为会影响女性患者的病情缓解（OR，0.48；95% CI，0.28-0.81）：我们证实了健康的生活方式与新发 2 型糖尿病患者糖尿病缓解之间的关系。本研究结果表明，糖尿病确诊后改善生活方式可能有助于病情缓解。Background: Lifestyle-related factors have been studied as a fundamental aspect in the onset and progression of type 2 diabetes mellitus. However, behavioral factors are easily overlooked in clinical practice. This study investigated whether lifestyle changes were associated with diabetes remission in newly diagnosed type 2 diabetes patients.
Methods: We enrolled patients with new-onset type 2 diabetes from 2009 to 2012 using a health examination cohort from the Korean National Health Insurance Service (KNHIS). Remission was defined as a fasting glucose level less than 126 mg/dL at least once during a health examination after stopping medication. A self-administered questionnaire was used to investigate patients' lifestyles. We investigated smoking, alcohol consumption, and regular exercise before and after starting diabetes medication and the odds ratios (ORs) of logistic regression on remission to evaluate the associations.
Results: A total of 138,211 patients diagnosed with type 2 diabetes from 2009 to 2012 were analyzed, and 8,192 (6.3%) reported remission during the follow-up period to 2017. Baseline fasting blood glucose level measured before starting diabetes medication was significantly higher in the non-remission group (180 mg/dL vs. 159 mg/dL, P < 0.001). In addition, the use rate of combined oral hypoglycemic agent treatment was higher in the non-remission group (15% vs. 8%, P < 0.001). Consistent smoking and drinking showed negative associations with remission (OR, 0.72; 95% confidence interval [CI], 0.67-0.77 and OR, 0.90; 95% CI, 0.84-0.95, respectively), and initiation of regular exercise presented a positive association with remission (OR, 1.54; 95% CI, 0.46-1.63). Abstinence from alcohol increased the likelihood of remission in the male population (OR, 1.20; 95% CI, 1.10-1.32). The association with smoking history or smoking cessation was not clear, but new smoking behavior interfered with remission in women (OR, 0.48; 95% CI, 0.28-0.81).
Conclusion: We confirmed associations between a healthy lifestyle and diabetic remission in new-onset type 2 diabetes patients. The results of this study suggest that improving lifestyle after diabetes diagnosis may contribute to disease remission.
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