抗阻力运动联合营养干预对老年2型糖尿病合并肌少症患者血糖稳定性影响的临床研究  

Effects of Resistance Exercise Combined with Nutritional Intervention on Blood Glucose Stability in Elderly Patients with Type 2 Diabetes Mellitus with Sarcopenia

作　　者：王颖 颜轶隽 刘蕾 胡毓敏 张扬 刘凯 姜博仁 WANG Ying;YAN Yijun;LIU Lei;HU Yumin;ZHANG Yang;LIU Kai;JIANG Boren(Health Management Clinic,Shanghai Huangpu District Yuyuan Community Health Service Center,Shanghai 200010,China;Ward Area 2,Shanghai Huangpu District Geriatric Care Hospital,Shanghai 200010,China;Department of Rehabilitation Medicine,Shanghai Huangpu District Geriatric Care Hospital,Shanghai 200010,China;Department of Endocrinology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海市黄浦区豫园街道社区卫生服务中心健康管理门诊,200010 [2]上海市黄浦区老年护理医院二病区,200010 [3]上海市黄浦区老年护理医院康复医学科,200010 [4]上海交通大学医学院附属第九人民医院内分泌科,上海市200011

出　　处：《中国全科医学》2025年第21期2604-2610,共7页Chinese General Practice

基　　金：中华国际医学交流基金(Z-2017-26-1902);上海市黄浦区卫生健康委员会科研项目(HLM202135)。

摘　　要：背景2型糖尿病与肌少症是两种危害老年人健康的常见病,目前国内关于2型糖尿病合并肌少症的临床干预研究较少。目的探讨在基层医院开展抗阻力运动联合营养干预对合并肌少症的老年2型糖尿病患者骨骼肌质量及血糖稳定性的影响。方法选取2022年2月—2024年5月于上海市黄浦区豫园街道社区卫生服务中心就诊的61例老年2型糖尿病合并肌少症的老年患者(≥65岁)作为研究对象,随机分为对照组(30例)及试验组(31例)。对照组进行常规糖尿病健康教育,试验组在对照组基础上进行抗阻力运动联合营养干预,干预12周后,比较两组患者的葡萄糖在目标范围内的时间(TIR)、平均血糖波动幅度(MAGE)、四肢骨骼肌质量指数(ASMI)、握力(kg)、6 m步速(m/s),并分析干预前后ASMI、握力、6 m步速改善程度与TIR、MAGE改善程度的相关性。结果干预前,两组一般资料比较,差异均无统计学意义(P>0.05)。干预12周后,对照组TIR较干预前降低(P<0.05);试验组糖化血红蛋白(HbA_(1c))、TIR、MAGE、6 m步速、优势手握力较干预前改善(P<0.05)。干预12周后,两组HbA_(1c)、TIR、MAGE、ASMI、6 m步速、优势手握力变化幅度比较,差异均有统计学意义(P<0.05)。6 m步速变化幅度与TIR变化幅度呈正相关(r_(s)=0.411,P<0.05),与MAGE(r_(s)=-0.472,P<0.05)和HbA_(1c)(r_(s)=-0.315,P<0.05)变化幅度呈负相关。两组均无不良事件发生。结论对合并肌少症的老年2型糖尿病患者,抗阻力运动联合营养干预不但可以增加肌肉量和身体功能,而且可以改善血糖稳定性和血糖达标时间。抗阻力运动和营养干预简便易行,安全性高,值得在基层医院推广应用。Background Type 2 diabetes mellitus(T2DM)and sarcopenia are common conditions that significantly impact the health of elderly individuals.However,clinical intervention studies focusing on T2DM with sarcopenia are relatively limited in China.Objective To investigate the effects of resistance exercise combined with nutritional intervention on skeletal muscle mass and blood glucose stability in elderly T2DM patients with sarcopenia at a primary care hospital.Methods A total of 61 elderly T2DM patients with sarcopenia(aged≥65)who attended the Shanghai Huangpu District Yuyuan Community Health Service Center between February 2022 and May 2024 were enrolled in the study.The patients were randomly assigned to a control group(n=30)and an intervention group(n=31).All patients were managed by routine diabetes education,and those in the intervention group additionally received resistance exercise combined with nutritional intervention.A 12-week intervention was performed to compare the time in glucose target range(TIR),mean amplitude of glycemic excursions(MAGE),appendicular skeletal muscle mass index(ASMI),grip strength,and 6-meter walking speed.The correlations between grip strength,6-meter walking speed,ASMI with TIR and MAGE were assessed before and after the intervention.Results Before the intervention,there was no significant difference in parameters between the two groups(P<0.05).After the 12-week intervention,significantly decreased TIR was detected in the control group(P<0.05),and significantly improved glycated hemoglobin(HbA_(1c)),TIR,MAGE,and 6-meter walking speed and grip strength were found in the intervention group(P<0.05),with statistical differences between group(s P<0.05).Before and after intervention,the change of HbA_(1c),TIR,MAGE,and 6-meter walking speed,ASMI,and grip strength showed statistically significant differences between control and intervention group(P<0.05).The change in 6-meter walking speed was positively correlated with the change in TIR(r_(s)=0.411,P<0.05),and negatively correlated with

关 键 词：抗阻训练 运动疗法 糖尿病 2型 肌少症 肌 骨骼 血糖控制 血糖稳定性 社区 随机对照试验 

分 类 号：R455[医药卫生—运动医学]