1、此處替換為文檔標題Short Report: Treatment Population response to information on reversibility of Type 2 diabetes短期報告：2型糖尿病可逆性的治療人群反應S. Steven, E. L. Lim and R. TaylorS.史提芬，E. L. Lim和R.泰勒Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK磁共振中心，紐卡斯爾大學醫學院，蜂窩，

2、泰恩河畔紐卡斯爾，英國Accepted 10 January 2013接受10一月20131. Abstract 摘要1.1. Aims 目的Following publication of the Counterpoint Study (on the reversibility of Type 2 diabetes using a very low energy diet), the extent of public interest prompted the authors to make available, on a website, general information about

3、 reversing diabetes. Shortly thereafter, individuals began to feed back their personal experiences of attempting to reverse their diabetes. We have collated this information on the effects of energy restriction in motivated individuals with Type 2 diabetes that has been achieved outside a research s

4、etting.以下的對位研究出版（對2型糖尿病患者采用極低能量飲食的可逆性），公共利益的程度上促使作者提供，網站上，關于糖尿病的一般信息。此后不久，個人開始反饋他們的個人經歷，試圖扭轉他們的糖尿病。我們已經整理了對動機的2型糖尿病患者已經實現外研究制定能源約束的影響這一信息。1.2. Methods 方法Emails, letters and telephone communications received between July 2011 and September 2012 were evaluated (n = 77: 66 men, 11 women). Median diabet

5、es duration was 5.5 years (3 months28 years). Reversal of diabetes was defined as achieving fasting capillary blood glucose < 6.1 mmol/l and/or, if available, HbA1c less than 43 mmol/mol (6.1%) off treatment.收到的電子郵件，信件和電話之間的通信在七月2011和九月2012進行了評價（77名：66名男子，11名婦女）。中位糖尿病病程5.5年（3個月，28年）。逆轉糖尿病被定義為實現空腹

6、毛細血管血糖6.1 mmol/L和/或，如果可用，糖化血紅蛋白小于43毫摩爾/摩爾（6.1%）治療。1.3. Results 結果Self-reported weight fell from 96.7 17.5 kg at baseline to 81.9 14.8 kg after weight loss (P < 0.001). Selfreported fasting blood glucose levels fell from 8.3 mmol/l (5.933.0) to 5.5 mmol/l (4.010.0) after the weight loss period (P

7、< 0.001). Diabetes reversal was considered to have occurred in 61% of the population. Reversal of diabetes was observed in 80, 63 and 53% of those with > 20, 1020 and < 10 kg weight loss, respectively. There was a significant correlation between degree of weight loss and reported fasting gl

8、ucose levels (Rs 0.38, P = 0.006). Reversal rates according to diabetes duration were: short (< 4 years) = 73%, medium (48 years) = 56% and long (> 8 years) = 43%.自報體重從17.5公斤下降到81.9 96.7公斤，體重減輕14.8公斤（0.001）。問卷訪空腹血糖水平從8.3 mmol/L下降（5.933）5.5毫摩爾/升（410）減肥期后（P0.001）。糖尿病逆轉被認為是發生在61%的人口。觀察20、63、53%、1

9、0、80和的糖尿病逆轉情況，分別為20和10。有一個顯著的相關性程度的減肥和空腹血糖水平（盧比）- 0.38，磷= 0.006）。根據糖尿病病程逆轉率：短（4年）= 73%，中（4 - 8年）= 56%和長（8年）= 43%。1.4. Conclusion 結論These data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabetes. Diabetes reversal should be a goal in t

10、he management of Type 2 diabetes.這些數據表明，故意減肥，實現在家中的健康動機的個人可以逆轉2型糖尿病。糖尿病逆轉應該是2型糖尿病管理的一個目標。Diabet. Med. 30, e135e138 (2013)糖尿病。基礎教學法碩士30，e135e138（2013）2. Introduction 簡介Publication about reversibility of Type 2 diabetes using a very low energy diet (the Counterpoint study 1) was followed by over 1000

11、enquiries from people with diabetes. The overwhelming sentiment expressed was profound relief at the possibility that the condition was not inevitably permanent.關于2型糖尿病用極低能量飲食的可逆性出版物（對位研究 1 ）是由超過1000的查詢，有糖尿病的人。這種強烈的情感表達了深刻的可能性，這種可能性是不可避免的。The extent of public interest prompted the authors to make av

12、ailable on a website general information about reversing diabetes, both for people with Type 2 diabetes and healthcare professionals 2. In this, it is explained that a very low energy diet was chosen in the research study to mimic the effects of gastric bypass surgery.公共利益的程度，促使作者在一個網站上提供關于扭轉糖尿病的一般信

13、息，這兩人與2型糖尿病和醫療保健專業人士 2 。在這一點，它被解釋為一個非常低的能量飲食選擇在研究研究，模仿胃旁路手術的影響。However, steady but substantial weight loss achieved by reducing portion size was recommended as the preferred method. The focus was on the need to achieve substantial and sustainable weight loss through the best approach for that indivi

14、dual. All individuals were advised to discuss their plans for energy restriction with their own doctor, particularly with a view to adjusting anti-diabetic medication.然而，穩定的，但實質性的減肥所取得的減少部分大小的建議作為首選方法。重點是要實現實質性和可持續的減肥，通過最佳的方法，為個人。建議所有的人與自己的醫生討論他們的能量限制計劃，特別是有針對性地調整抗糖尿病藥物。A separate document with info

15、rmation for doctors was available. No alterations to habitual physical activity levels were advised. Within a few months individuals began to feed back their personal experiences of attempting to reverse their diabetes. We have collated this information, which provides a unique demonstration of what

16、 is achievable by energy restriction in motivated individuals outside a research setting.一個單獨的文件與信息的醫生是可用的。對習慣性體力活動水平沒有改變的建議。在幾個月內，個人開始恢復自己的個人經歷，試圖扭轉他們的糖尿病。我們整理這些信息，它提供了一個獨特的個體是什么動機外研究制定能源約束實現的示范。3. Methods 方法Emails, letters and telephone communications between July 2011 and September 2012 were eval

17、uated (n = 77). Information on diabetes history, the nature of the diet undertaken, intentional weight loss achieved and zmprovement in glucose control was collected. Reversal of diabetes was defined as achieving a reported fasting capillary blood glucose less than 6.1 mmol/l and/or, if available, H

18、bA1c less than 43 mmol/mol (6.1%) off any anti-diabetic treatment. Plasma glucose levels were converted to whole blood glucose levels by dividing by a factor of 1.11 3. Results are expressed as mean SD or median and range when not normally distributed. Paired t-test, MannWhitney U-test and Spearman

19、rank sum were carried out (Minitab 15 Software; ).九月2011和七月2012之間的電子郵件，信件和電話通訊進行了評價（77）。糖尿病病史信息，自然的飲食進行減肥，收集了zmprovement血糖控制。逆轉糖尿病被定義為實現報道空腹毛細血管血糖低于6.1 mmol/L和/或，如果可用，糖化血紅蛋白小于43毫摩爾/摩爾（6.1%）任何抗糖尿病治療。血漿葡萄糖水平由1.11 3 的一個因子被轉換為整個血糖水平。結果被表示為平均值或中位數和范圍時，不正常分布。配對t檢驗，曼Mann-Whitney U檢驗和Spearman進行（Minitab 15軟件

20、；www.minitab。COM）。4. Results 結果The respondents (66 men, 11 women, 56.4 9.7 years) had median diabetes duration of 5.5 years (3 months to 28 years). Duration was further categorized as short (< 4 years) n = 30; medium (48 years) n = 25; long duration (> 8 years) n = 14. Prior to undertaking ene

21、rgy triction, diabetes treatments were: metformin (36); sulphonylurea (13); diet alone (10); insulin (6); glucagonlike peptide 1 (GLP-1) agonist (3); thiazolidinedione (3); dipeptidyl peptidase-4 inhibitor (2). Proprietary liquid meal replacements were used by 38 individuals and energy ntake was res

22、tricted without the use of special products in 34 individuals. Support from a healthcare practitioner uring the diet was reported by 27 people and 25 felt that they had a negative response to request for support. The median diet duration was 8 weeks (1104).調查對象（66名男性，11名女性，9.7名56.4歲），平均糖尿病病程5.5年（3個月

23、至28年）。進一步分為30年（4年）；中（4年8年）25；中長期（8年）14。承擔能源制約之前，糖尿病的治療：二甲雙胍（36）；磺脲類（13）；飲食（10）；（6）胰島素；胰高血糖素肽1（GLP-1）受體激動劑（3）；噻唑烷二酮（3）；二肽基肽酶抑制劑（2）。專有的液體膳食替代品被38個人能進沒有特殊產品的34個人使用的限制。從一個保健醫生在飲食支持由27人和25感到他們不得不請求支持負面反應。中位飲食時間為8周（1 - 104）。Self-reported weight fell from 96.7 17.5 kg at aseline and was 81.9 14.8 kg after

24、weight loss (P < 0.001). Selfreported fasting blood glucose levels fell from 8.3 mmol/l (5.933.0) to 5.5 mmol/l (4.010.0) after the weight-loss period (P < 0.001). Pre- and post-diet HbA1c was available in 20 subjects and fell from 58 mmol/mol (40115) 7.5% (5.812.7) to 45 mmol/mol (2657) 6.3%

25、(4.57.4) (P < 0.001). Diabetes reversal was considered to have occurred in 61% of the population. In the non-reversal group, improvements sufficient to allow discontinuation of anti-diabetic medications occurred in five individuals.自我報告的體重從96.7公斤到17.5從81.9下跌，14.8公斤減肥后（P0.001）。問卷訪空腹血糖水平從8.3 mmol/L

26、下降（5.933）5.5毫摩爾/升（410）減肥期后（P0.001）。前和后的飲食20者HbA1c可從58毫摩爾/摩爾下降（40115） 7.5%（5.812.7） 45毫摩爾/摩爾（2657） 6.3%（4.57.4）（P0.001）。糖尿病逆轉被認為是發生在61%的人口。在非逆轉組中，有足夠的改善，使五個人的抗糖尿病藥物的停止發生。Reversal of diabetes was observed in 80% of those with > 20 kg weight loss, 63% of those with weight loss 1020 kg and in 53% of

27、those with < 10 kg weight loss. The mean weight loss in individuals who reported diabetes reversal was 16.0 6.9 kg, and was 12.8 4.9 kg in those who did not achieve reversal of diabetes. There was a significant correlation between degree of weight loss (%) and reported fasting glucose levels (Rs

28、0.38, P = 0.006) (see Fig. 1). Of those achieving loss of > 20% of body weight, only three people did not achieve reversal of diabetes. The reversal rates in the short, medium and long duration groups were 73, 56 and 43%, respectively, and in those losing > 15 kg in weight the reversal rates w

29、ere 82, 64 and 75%, respectively.在80%的減肥者中有20的體重下降，63%的體重下降10，20公斤，53%的體重下降，其中10的人體重下降。在個人誰報告糖尿病逆轉的平均體重損失為6.9，16公斤，并在那些沒有達到逆轉糖尿病4.9 12.8公斤。有一個顯著的相關性之間的重量損失（%）和空腹血糖水平（盧比- 0.38，磷= 0.006）（見圖1）。其中20%的減肥者達到減肥，只有三人沒有達到逆轉糖尿病。短、中、長時間組的逆轉率分別為73、56和43%，而在減肥中的逆轉率分別為82、和64，分別為15和75%。Longer-term data from eight

30、of these individuals are available, indicating a sustained benefit on blood glucose levels following cessation of tight energy restriction. These individuals, all male, undertook an 8-week period of energy restriction, with four individuals using a meal replacement product. Sustained reversal of dia

31、betes was confirmed by HbA1c in six individuals and by oral glucose tolerance test in two individuals. Details on glycaemic control and weight change for these individuals are shown in Table 1.從這些人中的八個較長的長期數據是可用的，表明持續的利益，對血糖水平停止嚴格的能量限制。這些人，全部為男性，進行了能量限制8周，用代餐產品四個人。糖尿病持續逆轉證實了HbA1c在六個人和兩個人口服葡萄糖耐量試驗。這些

32、人在控制血糖及體重變化情況如表1所示。FIGURE 1 Self-reported fasting blood glucose levels at the end of the diet period in relation to the degree of achieved weight loss. The solid line at 6.1 mmol/l represents the diagnostic cut-off for diabetes reversal.圖1自我報告的空腹血糖水平在結束時的飲食與體重減輕的程度有關。在6.1毫摩爾/升的固體線代表診斷截斷糖尿病逆轉。5. Disc

33、ussionThe data suggest that very significant improvements in blood glucose levels can be made by energy restriction undertaken by motivated individuals in their usual environment. This is possible with minimal or no support from a healthcare practitioner. It is still widely believed that long-durati

34、on Type 2 diabetes results in an inevitable and irreversible decline in insulin secretion, with the inevitable requirement for insulin therapy after an average of 10 years 4. Six individuals with long-duration disease (928 years) reported reversal of diabetes.討論的數據表明，在血液中的葡萄糖水平的非常顯著的改善，可以通過在其通常的環境中的

35、動機的個人進行的能量限制。這是可能的，最小的或不支持的醫療保健醫生。它仍然被廣泛認為，持續時間長2型糖尿病的結果是不可避免的和不可逆的胰島素分泌下降，胰島素治療的必然要求，平均10年后 4 。六個人的長期病程（9年）報告逆轉糖尿病。This is in keeping with observations following bariatric surgery, that some individuals will achieve normalization of blood glucose levels, even although remission rates decrease when

36、disease duration is more than 10 years 5. Although the use of very low energy diets tends to be followed by weight regain, some people are able to avoid this 6,7 and our data confirm this. Modification of dietary fat content may have a beneficial effect following intentional weight loss 8. Further w

37、ork is needed to define the optimum method for maintaining normal glucose toleranceafter the return to normal eating.這是符合減肥手術后的觀察，一些人將實現血糖水平正常，即使當病程超過10年 5 降低緩解率。雖然極低能量飲食的使用往往是由體重恢復，有些人能夠避免這個 6,7 和我們的數據證實了這個。膳食脂肪含量的修改可能有一個有益的影響以下故意減肥 8 。進一步的工作是需要定義為維持正常血糖toleranceafter恢復正常飲食的最佳方法。The study populatio

38、n represents a group of individuals motivated to regain their health, and this is an important point. The crucial factor which differentiates this dietary intervention from previous attempts is the clearly identified goal of becoming free of Type 2 diabetes. The distinction between the treatment of

39、a potentially curable disease and that of a chronic progressive condition was made eloquently by one individual, who contrasted the often reported battle to beat a life-threatening disease such as cancer with the learned helplessness induced by advice that diabetes was inevitably progressive.研究人群代表了

40、一組個人的動機，以恢復他們的健康，這是一個重要的觀點。的關鍵因素，區分這一飲食干預，從以前的嘗試是明確確定的目標，成為自由的2型糖尿病。區別可能治愈的疾病的治療之間，慢性進展性條件是充分的一個人，他對比了經常報道的戰斗，打敗一個危及生命的疾病，如與習得性無助的建議，糖尿病是不可避免的進步引起的癌癥。The responses clearly show that this minority of health-motivated people strongly resent being told that there is nothing that can be done to escape f

41、rom Type 2 diabetes and that they must take medication. The overwhelming impression gained by doctors from their routine clinical practice is that people with Type 2 diabetes rarely succeed in losing weight, and the critical point that there is a subgroup who are strongly motivated by desire to rega

42、in health has not been widely recognized. Some doctors do know that occasionally people do reverse their diabetes, but this is not acknowledged by clinical guidelines 9. The pathophysiological basis for this has previously been described 10.反應清楚地表明，這少數的健康動機的人強烈不滿被告知，沒有任何可以做，以擺脫2型糖尿病，他們必須采取藥物。醫生從他們的日

43、常臨床實踐中得到的壓倒性的印象是，2型糖尿病患者很少能成功地減肥，而關鍵的一點是，有一個亞組誰是強烈動機的愿望，恢復健康并沒有得到廣泛認可。有些醫生確實知道，偶爾的人會改變他們的糖尿病，但這是不承認的臨床指南 9 。以前被描述的病理生理基礎 10 。Table 1 Sustained benefit on weight and blood glucose levels following a period of energy restriction in eight individuals表1: 持續的獲益于體重和血糖水平, 在八個個體的能量限制期后Observations in uncont

44、rolled free-living populations make this study unique and reflect the prospects for what can be achieved beyond the research environment. However, the limitations inherent to this study design must be acknowledged. Firstly, there will have been self-referral bias, with the observations demonstrating

45、 proof of principle rather than any estimate of likely reversal rates. The precision of the diagnosis of Type 2 diabetes is uncertain. The inclusion of individuals with maturity-onset diabetes of youth or slow-onset Type 1 diabetes would result in an underestimation of rates of diabetes reversal usi

46、ng a very low energy diet.在不受控制的自由生活的人群的觀察，使這項研究獨特的反映所能取得的成就超越環境的研究前景。然而，固有的局限性，本研究設計必須承認。首先，將有自我轉介偏見，與觀察證明的原則，而不是任何可能的逆轉率的估計。2型糖尿病診斷的準確性是不確定的。與青年或緩慢起病的1型糖尿病發病的成年型糖尿病患者納入會導致低估率糖尿病逆轉用極低能量飲食。The significant degree of heterogeneity in the intervention must also be acknowledged, including the degree of

47、energy restriction (particularly in those who did not use a meal replacement product) and the length of diet period undertaken. Finally, diabetes reversal was mostly based on self-reported, unverified measurements of glycaemic control in the form of capillary blood glucose results, fasting plasma gl

48、ucose results, HbA1c or oral glucose tolerance tests.在干預的顯著程度的異質性，也必須承認，包括限制的能量限制（特別是在那些沒有使用的膳食替代產品）和飲食期間的長度進行。最后，糖尿病逆轉主要是基于自我報告，在毛細管血糖結果形成血糖控制未經證實的測量結果，空腹血糖，糖化血紅蛋白或口服葡萄糖耐量試驗。These data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabe

49、tes. Diabetes reversal should be a goal in the management of Type 2 diabetes in these individuals. The durability of the effect on glucose metabolism requires further study. Long-term avoidance of weight gain must be the top priority after reversal of diabetes, and the dietary regimen best able to a

50、chieve this must now be established.這些數據表明，故意減肥，實現在家中的健康動機的個人可以逆轉2型糖尿病。糖尿病的逆轉應該是一個目標，在這些人的2型糖尿病的管理。對糖代謝的影響的耐久性需要進一步研究。長期避免體重增加必須是糖尿病逆轉后的重中之重，而現在必須建立的飲食方案最好能達到這個。Funding sources資金來源None.無。Competing interests競爭利益None declared.沒有聲明。6. References1 Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes is associated with decrease in pancreas and liver fat. Diabetologia 2011; 54: 25062514.2 Taylor R. Reversing Type 2 D