OBJECTIVE To examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype. RESEARCH DESIGN AND METHODS This post hoc analysis of the multicenter, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1,510 participants with prediabetes (BMI ≥25 kg ⋅ m−2; defined using oral glucose tolerance tests). Of these, 58% had isolated impaired fasting glucose (iIFG), 6% had isolated impaired glucose tolerance (iIGT), and 36% had IFG+IGT; 73% had normal hemoglobin A1c (HbA1c; <39 mmol ⋅ mol−1) and 25% had intermediate HbA1c (39–47 mmol ⋅ mol−1). Participants underwent an 8-week diet-induced rapid weight loss, followed by a 148-week lifestyle-based weight maintenance intervention. Linear mixed models adjusted for intervention arm and other confounders were used. RESULTS In the available-case and complete-case analyses, participants with IFG+IGT had greater sustained weight loss after lifestyle intervention (adjusted mean at 156 weeks −3.5% [95% CI, −4.7%, −2.3%]) than those with iIFG (mean −2.5% [−3.6%, −1.3%]) relative to baseline (P = 0.011). Participants with IFG+IGT and iIFG had similar cardiometabolic benefits from the lifestyle intervention. The differences in cardiometabolic benefits between those with iIGT and IFG+IGT were minor or inconsistent in different analyses. Participants with normal versus intermediate HbA1c had similar weight loss over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA1c had greater improvements in fasting glucose, 2-h glucose (adjusted between-group difference at 156 weeks −0.54 mmol ⋅ L−1 [95% CI −0.70, −0.39], P < 0.001), and triglycerides (difference −0.07 mmol ⋅ L−1 [−0.11, −0.03], P < 0.001) during the lifestyle intervention. CONCLUSIONS Individuals with iIFG and IFG+IGT had similar improvements in cardiometabolic health from a lifestyle intervention. Those with normal HbA1c had greater improvements than those with intermediate HbA1c.

中文翻译：

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3 年生活方式干预对体重和心脏代谢健康的影响是否因前驱糖尿病代谢表型而异？PREVIEW 研究的事后分析

目的 研究 3 年生活方式干预对体重和心脏代谢危险因素的影响是否因前驱糖尿病代谢表型而异。研究设计和方法 这项多中心随机试验的事后分析，通过欧洲和世界各地的生活方式干预和人口研究预防糖尿病（预览），包括 1,510 名糖尿病前期参与者（BMI ≥ 25 kg ⋅ m−2；定义为使用口服葡萄糖耐量试验）。其中，58% 患有单纯空腹血糖异常 (iIFG)，6% 患有单纯葡萄糖耐量异常 (iIGT)，36% 患有 IFG+IGT；73% 的血红蛋白 A1c 正常（HbA1c；<39 mmol ⋅ mol-1），25% 的 HbA1c 处于中间值（39-47 mmol ⋅ mol-1）。参与者经历了为期 8 周的饮食诱导的快速减肥，随后进行为期 148 周的基于生活方式的体重维持干预。使用针对干预组和其他混杂因素调整的线性混合模型。结果 在可用病例和完整病例分析中，IFG+IGT 参与者在生活方式干预后体重持续减轻（156 周调整平均值 -3.5% [95% CI, -4.7%, -2.3%]）比那些iIFG（平均 −2.5% [−3.6%，−1.3%]）相对于基线 (P = 0.011)。IFG+IGT 和 iIFG 的参与者从生活方式干预中获得了相似的心脏代谢益处。在不同的分析中，iIGT 和 IFG+IGT 患者的心脏代谢益处差异很小或不一致。HbA1c 正常与中间水平的参与者在 3 年内体重减轻相似，体重减轻期间的心脏代谢益处略有不同，而 HbA1c 正常的患者在空腹血糖、2 小时血糖方面有更大改善（调整后的组间差异在 156 周时为 -0.54 mmol ⋅ L-1 [95% CI -0.70, -0.39]，P < 0.001）和生活方式干预期间的甘油三酯（差异 -0.07 mmol ⋅ L-1 [-0.11，-0.03]，P < 0.001）。结论 患有 iIFG 和 IFG+IGT 的个体通过生活方式干预在心脏代谢健康方面有相似的改善。具有正常 HbA1c 的患者比具有中间 HbA1c 的患者有更大的改善。结论 患有 iIFG 和 IFG+IGT 的个体通过生活方式干预在心脏代谢健康方面有相似的改善。具有正常 HbA1c 的患者比具有中间 HbA1c 的患者有更大的改善。结论 患有 iIFG 和 IFG+IGT 的个体通过生活方式干预在心脏代谢健康方面有相似的改善。具有正常 HbA1c 的患者比具有中间 HbA1c 的患者有更大的改善。