连续性及高强度间歇运动对2型糖尿病血糖调控影响的研究进展

规律运动可以帮助预防和改善2型糖尿病患者血糖控制情况，降低心血管疾病发生风险。本文综述了有氧运动对2型糖尿病血糖的改善情况，尤其是连续性及高强度间歇运动对2型糖尿病对血糖调控的影响，得出高强度间歇运动可调节骨骼肌中葡萄糖代谢情况，降低空腹血糖及糖化血红蛋白；3次/周及每周总计150 min以上的中等强度有氧运动被认为是改善2型糖尿病的症状最佳方案，且训练频率越高及训练量越大对于2型糖尿病病情的改善越有效；抗阻训练同样能增强胰岛素的作用，但抗阻介入有氧运动及抗阻介入高强度间歇训练能否对2型糖尿病产生更大的改善效果尚需更多的试验去验证。     

Exercise in prediabetes

Exercise as a therapeutic modality in the management of type 2 diabetes is well established. However, exercise has emerged as an important tool to prevent, or at least, to delay the onset of type 2 diabetes. This has been borne out by a few recent clinical trials. Exercise improves insulin sensitivity besides having beneficial effects on many cardiovascular risk factors. A sedentary adult at high risk for developing diabetes may benefit from at least 30 minutes of daily moderate-intensity exercise.     

跑台运动训练对2型糖尿病大鼠股骨骨密度的影响

目的研究不同强度跑台运动训练对2型糖尿病大鼠股骨骨密度的影响,为探讨有氧运动对2型糖尿病骨并发症的防治提供实验依据。方法选取52只8周龄健康雄性SD大鼠,随机分成正常对照组10只和2型糖尿病造模组42只。造模组大鼠在高糖、高脂和高能量饲料喂养4周后,一次性腹腔注射链脲佐菌素30mg／kg,以建立2型糖尿病大鼠模型。取30只造模成功的2型糖尿病大鼠,随机分成糖尿病对照组、小强度运动组和中强度运动组,每组10只。运动组实施8周运动方案。采用固体物理密度仪测定实验大鼠股骨骨密度。结果与正常对照组相比,糖尿病对照组和小强度运动组的股骨骨密度显著降低（P〈0．05）,中强度运动组的股骨骨密度显著升高（P〈0．05）;与糖尿病对照组、小强度运动组相比,中强度运动组股骨骨密度显著升高（P〈0．01）。结论①2型糖尿病大鼠股骨骨密度低于正常,为骨质疏松症高危群体;②跑台运动训练对2型糖尿病大鼠股骨骨密度的影响与运动强度有关。     

Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials

CONTEXT: Exercise is widely perceived to be beneficial for glycemic control and weight loss in patients with type 2 diabetes. However, clinical trials on the effects of exercise in patients with type 2 diabetes have had small sample sizes and conflicting results. OBJECTIVE: To systematically review and quantify the effect of exercise on glycosylated hemoglobin (HbA(1c)) and body mass in patients with type 2 diabetes. DATA SOURCES: Database searches of MEDLINE, EMBASE, Sport Discuss, Health Star, Dissertation Abstracts, and the Cochrane Controlled Trials Register for the period up to and including December 2000. Additional data sources included bibliographies of textbooks and articles identified by the database searches. STUDY SELECTION: We selected studies that evaluated the effects of exercise interventions (duration >/=8 weeks) in adults with type 2 diabetes. Fourteen (11 randomized and 3 nonrandomized) controlled trials were included. Studies that included drug cointerventions were excluded. DATA EXTRACTION: Two reviewers independently extracted baseline and postintervention means and SDs for the intervention and control groups. The characteristics of the exercise interventions and the methodological quality of the trials were also extracted. DATA SYNTHESIS: Twelve aerobic training studies (mean [SD], 3.4 [0.9] times/week for 18 [15] weeks) and 2 resistance training studies (mean [SD], 10 [0.7] exercises, 2.5 [0.7] sets, 13 [0.7] repetitions, 2.5 [0.4] times/week for 15 [10] weeks) were included in the analyses. The weighted mean postintervention HbA(1c) was lower in the exercise groups compared with the control groups (7.65% vs 8.31%; weighted mean difference, -0.66%; P<.001). The difference in postintervention body mass between exercise groups and control groups was not significant (83.02 kg vs 82.48 kg; weighted mean difference, 0.54; P =.76). CONCLUSION: Exercise training reduces HbA(1c) by an amount that should decrease the risk of diabetic complications, but no significantly greater change in body mass was found when exercise groups were compared with control groups.     

口服葡萄糖耐量试验后1h高血糖的研究进展

口服葡萄糖耐量试验后1 h高血糖是正常糖耐量过渡到2型糖尿病的异常糖代谢状态,它是2型糖尿病和心血管疾病的独立危险因素,与正常血糖人群相比,其胰岛β细胞功能已经降低,更容易发展成为葡萄糖调节受损或2型糖尿病的状态。控制体质量,适当的运动,服用双胍类均可改善胰岛β细胞功能,从而降低血糖水平。     

糖尿病患者运动试验中心率恢复对心血管事件的预测

运动试验中心率恢复异常与心肌缺血、心肌损害、心脏自主神经功能受损、窦房结功能等因素相关。目前的研究证实运动试验中异常的心率恢复可反映心肌缺血、心脏自主神经病变,对心血管疾病的诊断及预后判断有重要的应用价值。冠状动脉粥样硬化性心脏病、心脏自主神经病变是糖尿病患者的常见并发症,严重影响糖尿病患者的预后。在此就糖尿病患者运动试验中心率恢复对心血管事件的预测价值研究现状予以综述。     

2型糖尿病患者的个体化运动处方

运动对控制2型糖尿病具有重要作用,运动治疗是现代糖尿病管理的主要内容之一.2010年岁末,美国运动医学会和美国糖尿病协会联合发表2型糖尿病运动最新指南,中华医学会糖尿病分会也在<中国2型糖尿病防治指南>中对运动进行明确规定.指南的落实需要个体化的运动处方和运动方案.本文对个体化运动处方的制定、抗阻运动、糖尿病并发症患者...     

改善2型糖尿病患者心血管事件预后的研究

胰岛素抵抗是2型糖尿病的基本缺陷。胰岛素抵抗可导致高胰岛素血症,常与动脉粥样硬化和心血管意外事件有关。本文旨在探讨高胰岛素血症和胰岛素抵抗的治疗策略,以及如何改善2型糖尿病心血管疾病的不良预后。     

运动负荷试验在糖尿病量化运动处方中的应用

目的 探讨采用心率与血乳酸值结合、利用无氧阈心率指导运动训练方法,为2型糖尿病患者制定个性化量化运动处方的可行性.方法 50例2型糖尿病患者均进行心电图踏车运动试验,每2 min递增20 W的运动功率,每个等级运动末检测血浆乳酸水平,运动过程中自动描记12导联心电图并自动监测血压等数据.运动试验终止标准据美国运动医学会...     

从心血管结局看降糖药物治疗的新进展

糖尿病患者发生冠心病的风险较非糖尿病患者明显升高,且心血管疾病是2型糖尿病患者最主要的致死原因。传统降糖药物尽管降糖疗效显著,但缺乏对心血管结局的良好评估。新型降糖药物经过大型临床试验确保了疗效和对心血管结局的安全性。本文从降糖药物对心血管结局影响的角度,介绍传统降糖药物及新型降糖药物在糖尿病治疗中的心血管安全性,指出某些新型降糖药物如钠-葡萄糖共转运蛋白2抑制剂（SGLT-2i）和胰高血糖素样肽1受体激动剂（GLP-1RAs）在2型糖尿病患者中具有良好心血管保护作用,其治疗地位在多项指南中得到提升,成为2型糖尿病合并心血管疾病患者的重要选择。本文结合多项国内外最新临床证据对糖尿病治疗药物对心血管结局的影响进行分析、总结,以期为临床医疗工作者制定糖尿病治疗策略提供参考。     

Insulin resistance and coronary artery disease

A large body of clinical evidence supports aggressive cardiovascular risk management in combination with glycaemic control in patients with type 2 diabetes and insulin resistance. Glycaemic management in a patient with HbA1c that is at or near goal should include an assessment of postprandial glycaemia. Insulin sensitisers have glycaemic and non-glycaemic benefits and warrant consideration even if the HbA1c is not significantly elevated. Oral agents should always be combined with lifestyle modification, including regular exercise and attention to both individual food choices and overall calorie intake to further optimise glycaemic control. For cardiovascular risk reduction, LDL cholesterol as well as HDL cholesterol and triglycerides should be treated appropriately through lifestyle changes. Often pharmacotherapy with at least one lipid-lowering agent is required. Blood pressure control often requires the use of 3 or more antihypertensive agents in patients with diabetes. Clinical data support use of an ACE-inhibitor as first-line therapy for the prevention of micro-albuminuria in patients with diabetes and hypertension. Urine should be tested for micro-albumin at least annually. Low-dose (81 mg) aspirin is appropriate for patients over age 45 years for primary prevention of coronary heart disease. Multifactorial intervention has been shown in large studies such as the Diabetes Prevention Programme and Steno-2 to have significant cardiovascular benefit among patients at risk of developing diabetes and those with type 2 diabetes and micro-albuminuria. Evidence-based treatments and therapeutic goals can build a practical framework for comprehensive outpatient management of patients with type 2 diabetes and insulin resistance. Data from important ongoing studies will continue to shape this framework in the years ahead.     

Postprandial dysmetabolism and cardiovascular disease in type 2 diabetes

The worldwide prevalence of type 2 diabetes mellitus has reached epidemic proportions. The so-called traditional risk factors cannot fully explain the excessive cardiovascular disease risk of type 2 diabetic patients. Numerous studies indicate that postprandial metabolic derangements, most notably hyperglycaemia and hypertriglyceridaemia, which are exaggerated and prolonged in type 2 diabetes, are important cardiovascular disease risk factors since they induce oxidative stress and endothelial dysfunctions. This review discusses the current evidence showing that postprandial dysmetabolism may indeed constitute an important cardiovascular disease risk factor as well as the mechanisms underlying this association. Finally, some possible therapeutic options and recommendations for future research are discussed.     

新型降糖药物替西帕肽的临床研究进展

目前全球有多种治疗糖尿病的药物，但仍有很多糖尿病患者未能达到推荐的目标血糖水平，研发和应用新型降糖药迫在眉睫。2022年5月，美国食品药品监督管理局（FDA）批准葡萄糖依赖性促胰岛素多肽（GIP）和胰高糖素样肽-1(GLP-1)双重受体激动剂替西帕肽上市，辅助饮食和运动，每周注射1次以改善成人2型糖尿病患者的血糖控制。多项临床研究已验证其用于2型糖尿病的有效性和安全性，同时该药在肥胖症、心血管风险相关疾病、非酒精性脂肪性肝炎等疾病治疗方面也具有潜在的应用价值。本文通过对替西帕肽的作用机制、有效性和安全性进行综述，为其在我国上市后的临床应用提供参考。     

运动对1型糖尿病大鼠心肌细胞中磷酸受纳蛋白表达的影响

目的观察运动对1型糖尿病大鼠心肌细胞中磷酸受纳蛋白（PLB）表达影响及其意义。方法40只健康SD大鼠随机分为正常对照组、运动对照组、糖尿病组及糖尿病＋运动组4组,每组10只。糖尿病大鼠模型复制成功后第4天开始跑台运动,于运动第4周末心脏采血收集血清,放射免疫法测定血清胰岛素水平,RT—PCR和Western-blotting法检测心肌细胞中磷酸受纳蛋白的表达。结果与正常对照组比较,糖尿病组血糖、糖化血清蛋白水平升高（P〈0．01）,血清胰岛素水平降低（P〈0．01）,心肌细胞PLB mRNA和蛋白表达无显著变化（P〉0．05）,糖尿病＋运动组血糖及糖化血清蛋白水平均升高（均P〈0．01）,心肌细胞中PLB mRNA和蛋白表达上调（P〈0．01）。与糖尿病组比较,糖尿病＋运动组血糖及糖化血清蛋白水平均降低（均P〈0．05）,PLB mRNA和PLB蛋白表达水平均升高（均P〈0．05）。结论运动对1型糖尿病大鼠心肌损伤有防治作用,其机制与运动能上调PLB基因表达可能有关。     

Coronary risk factors in type II diabetes: response to low-intensity aerobic exercise

Patients with non-insulin-dependent diabetes are at greatly increased risk for coronary artery disease. Although exercise training has been shown to decrease risk factors, the presence of obesity, older age, and a sedentary lifestyle make a high-intensity exercise program an unrealistic choice of therapy. Therefore, we examined the effect of a low-to-moderate-intensity (mean 69 per cent of maximal heart rate) walking program on lipids, glucose, insulin, glycosylated hemoglobin and cardiovascular fitness. Nine women and seven men, mean age 56, were randomly assigned to a control or an exercise group which exercised three times per week for two months. Supervised exercise sessions consisted of 40-45 minutes of walking and/or slow jogging. Subjects continued on their usual diets. The trained group showed a significant improvement in VO2max from 1.65 to 1.95 L/min. Resting systolic blood pressure decreased from 141 to 130 mm Hg after training, and resting heart rate decreased from 88 to 81. Glycosylated hemoglobin decreased in the exercise group in seven or eight subjects and in only two of eight controls. Triglycerides decreased in the exercise group from 285 to 223 mg/dl. Body weight, total and HDL cholesterol, glucose, and insulin did not change in either group. These data indicate that a low-to-moderate level of aerobic training, independent of dietary changes, is an effective and feasible method of improving cardiovascular risk factors: physical fitness, systolic blood pressure, plasma triglycerides, and glycemic control in non-insulin-dependent diabetic subjects.     

2型糖尿病运动疗法的疗效分析

目的：探讨对2型绪尿病患者进行中等强度的运动干预，观察治疗前后血糖、血脂、体重指数（BMI）、糖化血红蛋白等指标的变化情况。方法：对35例2型糖尿病患者在饮食和口服降糖药物治疗的同时，给予每周3次中等强度的运动疗法，共6个月，观察治疗前后上述各项指标的变化，并以35例饮食和口服降糖药物治疗的2型糖尿病患者作对照。结果：运动组的空腹及餐后2h血糖、糖化血红蛋白、BMI、总胆固醇、甘油三酯、低密度脂蛋白均有明显降低，且明显优于对照组（P〈0．05）。结论：运动疗法能明显改善2型糖尿病患者的血糖、血脂、糖化血红蛋白、体重、腰围和体重指数，较单纯药物和饮食疗法有更好的疗效。     

Diabetes in Australian aboriginal and Torres Strait Islander peoples

Type 2 diabetes arises from a complex and multifactorial set of factors, including genetic susceptibility, behaviour (including diet and exercise), early nutrition, obesity and psychosocial stress, leading to insulin resistance and pancreatic failure. These factors in turn are influenced by social and physical environmental factors. Each of these may be important determinants of the high prevalence and incidence of type 2 diabetes in Australian Aboriginal and Torres Strait Islander people. Public health interventions for primary and secondary prevention need to recognize this complexity. Although a reduction in the prevalence of obesity or diabetes in the short-medium term is rarely if ever achieved, there are documented examples of community-based programs which have been effective in reducing the risk of developing type 2 diabetes and its cardiovascular complications. Such interventions need to be community-directed and appropriate to local circumstances in order to be effective.     

运动训练联合药物治疗对2型糖尿病心脏自主神经病变的影响研究

目的 探讨运动对2型糖尿病患者心脏自主神经病变(CAN)的影响及心率恢复(HRR)的相关危险因素.方法 选取确诊为2型糖尿病患者105例为研究对象,所有患者治疗前、后均行口服葡萄糖耐量试验和活动平板试验,分析导致HRR异常的相关危险因素.根据不同的治疗方案,将HRR异常分为普通治疗组和强化治疗组,普通治疗组应用二甲双胍辅并控制饮食,强化治疗组在此基础上接受轻度强化运动训练,对比两组患者治疗前、后的临床生化指标和HRR的变化情况.结果 异常HRR与空腹血糖(FBG)、糖化血红蛋白(HbA1c)、静息心率、最大心率及收缩压(SBP)呈明显相关(P＜0.05).经过2个月的轻度强化运动训练后,普通治疗组和强化治疗组患者的FBG、HbA1c及静息心率较治疗前明显下降(P＜0.05),HRR明显增加;与普通治疗组治疗后相比,强化治疗组治疗后的FBG、HbA1c、静息心率明显下降,HRR明显增加(P＜0.05).结论 FBG、HbA1c、静息心率是影响2型糖尿病患者HRR异常重要的危险因素,轻度强化运动训练能够降低血糖水平,增加HRR,进而有效地改善CAN.     

Exercise intervention in New Zealand Polynesian peoples with type 2 diabetes: Cultural considerations and clinical trial recommendations

The Maori and Pacific Islands peoples of New Zealand suffer a greater burden of type 2 diabetes mellitus (T2DM) and associated comorbidities than their European counterparts. Empirical evidence supports the clinical application of aerobic and resistance training for effective diabetes management and potential remission, but few studies have investigated the effectiveness of these interventions in specific ethnic cohorts. We recently conducted the first trial to investigate the effect of prescribed exercise training in Polynesian people with T2DM. This article presents the cultural considerations undertaken to successfully implement the study. The research procedures were accepted and approved by cultural liaisons and potential participants. The approved methodology involved a trial evaluating and comparing the effects of two, 16-week exercise regimens (i.e. aerobic training and resistance training) on glycosylated haemoglobin (HbA1c), related diabetes markers (i.e. insulin resistance, blood lipids, relevant cytokines and anthropometric and hemodynamic indices) and health-related quality of life. Future exercise-related research or implementation strategies in this cohort should focus on cultural awareness and techniques to enhance participation and compliance. Our approach to cultural consultation could be considered by researchers undertaking trials in this and other ethnic populations suffering an extreme burden of T2DM, including indigenous Australians and Americans.