Читать книгу Clinical Dilemmas in Diabetes - Группа авторов - Страница 27

In 1986, a population‐based survey identified subjects in Da Qing, China with IGT [79]. These subjects were then randomized into four groups: control group, diet only, exercise only, and diet plus exercise. At six years post randomization, the mean rate of DM was significantly higher in the control group at 66%, compared to 47% in the diet group, 45% in the exercise group, and 44% in the diet plus exercise group.

The original Da Qing participants were followed for up to 30 years after randomization to assess the effects of intervention of DM incidence, microvascular and macrovascular complications, and mortality [80]. Active intervention occurred for the first six years after randomization until 1992, after which subjects were informed of the study results and asked to continue with normal medical care. No specific interventions were offered after the initial six years, and the three intervention groups were combined into one group for analysis purposes.

Over the 30‐year follow‐up period, the intervention group had a median delay in DM onset by four years (NNT 10) compared to the control group and a significantly lower cumulative incidence of DM onset (HR 0.61) [80]. At 30 years, there were 26% fewer CVD events in the intervention group compared to the control group. The difference between the two groups continued to increase over time.

At 30 years, the incidence of retinopathy was 40% lower in the intervention group than in the control group, and incidence of nephropathy and neuropathy were numerically lower in the intervention group but not significantly different [80]. The median delay of composite microvascular disease outcome was 5.2 years in the intervention group (NNT 10). Cardiovascular and all‐cause mortality were also significantly lower in the intervention group (25.6% and 35.2%, respectively) than in the control group (45.5% and 56.3%, respectively). The median delay in CVD death and all‐cause mortality in the intervention group were 7.3 years and 4.8 years, respectively, with NNT of 10 for both outcomes.