| Objective: Through observing the clinical efficacy of the comprehensive weight loss program in treating obese Type 2 Diabetes Mellitus(T2DM)combined with Nonalcoholic Fatty Liver Disease(NAFLD),evaluating the effectiveness,practicability and safety of the comprehensive weight loss program,explore the related mechanisms of visceral fat reduction combined with obese T2 DM combined with NAFLD prevention and treatment led by comprehensive weight loss programs,with a view to seeking effective interventions to prevent obese T2 DM combined with NAFLD.Methods: A controlled trial was performed on 180 patients who were diagnosed as obese T2 DM with NAFLD in the endocrinology department or inpatient department of our hospital from January 2018 to March 2019,and the patients were randomly divided into the study group of 120 cases and the control group of 60 cases in a ratio of 2:1.The intervention lasted for 3months.During the entire intervention period,the two groups of patients were adjusted by the endocrinology specialists according to the condition to adjust the hypoglycemic drugs.The research group gave a comprehensive weight loss program,including psychological counseling,acupuncture and thread embedding,diet and exercise control,diary Therapy(record weight loss diary,strengthen self-supervision and improve compliance),and provide one-to-one health guidance through a professional health management platform throughout the intervention,giving real-time supervision and detailed and timely adjustment of individualized plans.The control group received detailed routine diabetes diet and exercise health education in accordance with the 2017 version of the diabetes prevention and treatment guidelines.Specific diet and exercise therapy are not subject to mandatory intervention.Observe and compare the increase and decrease of hypoglycemic drugs,body mass index(BMI),fasting blood-glucose(FBG),and blood glucose at 2 hours after meal(2hPBG),glycated hemoglobin(HbA1c),Fasting insulin(FINS),Homeostasis model assessment of insulin resistance(HOMA-IR),Homeostasis model assessment of beta cell function index(HOMA-?),total cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL-C),and alanine aminotransferase(ALT),Aspartate aminotransferase(AST),Uric Acid(UA)and other changes,and color Doppler ultrasound was used to detect changes in NAFLD before andafter intervention.Results:(1)Comparison between the two groups: The FBG,2hPBG,HbAlc,FINS,HOMA-IR,TC,TG,LDL-C,ALT,and UA of the study group and the control group were all lower than the baseline after the intervention(P<0.05);HOMA-? in the study group increased,BMI decreased significantly(P<0.05),weight loss was up to 12.5kg,and the control group had no significant change(P>0.05);The AST in the control group was lower than the baseline after the intervention(P<0.05),and there was no significant change in the study group(P>0.05).(2)Comparison between the two groups: The improvement of glucose metabolism indexes(FBG,2hPBG,HbAlc,FINS,HOMA-IR,HOMA-?),obesity-related indexes(body weight,BMI),blood lipid(TC,TG,ldl-c),ALT and UA in the study group were significantly higher than those in the control group(P<0.05).The decrease of AST in the control group was more significant than that in the study group(P<0.05).(3)The discontinuation rate of the study group reached 60.68%,and all the remaining patients who did not discontinue the medication could reduce the drug to control blood sugar,the total reduction and discontinuation rate reached 100%.In the control group,none of the patients discontinued the medication,and the drug reduction rate was 28.57%,showing a significantdifference between the two groups(P<0.05).(4)After the intervention of the study group,only one person's liver color Doppler ultrasound still indicated fatty liver,the improvement rate of NAFLD was 99.15%,and the effective rate of the control group was 32.14%.The difference is obvious(P<0.05).Conclusion: The comprehensive weight loss program is significantly better than conventional treatment for diabetes in improving obesity-related indicators,glucose and lipid metabolism indicators,and fatty liver in obese T2 DM patients with NAFLD.Moreover,the comprehensive weight loss program can reduce the use of hypoglycemic drugs in patients,and even enable some patients to achieve glycemic control after discontinuation of hypoglycemic drugs.The comprehensive weight loss program has good efficacy and safety,and greatly improves patient compliance due to professional management and effective supervision.It is an effective intervention method for the prevention and treatment of obese T2 DM combined with NAFLD. |
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