成人2型糖尿病和糖尿病前期治疗与缓解的生活方式干预：ACLM指南（2025）

发布时间：2026-01-11 14:12

了解糖尿病类型（1型、2型等）以选择合适治疗 #生活知识# #科技生活# #健康生活技巧# #糖尿病#

成人2型糖尿病和糖尿病前期治疗与缓解的生活方式干预：ACLM指南（2025）

制定者：

美国生活方式医学会(ACLM,American College of Lifestyle Medicine)

2025年6月9日

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摘要:

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Objective: Diabetes is a defining disease of the 21st century because of its rising prevalence, association with obesity, and enormous health impact. Abundant evidence shows that lifestyle interventions can delay or prevent type 2 diabetes (T2D) in adults, offer relief, and sometimes achieve complete remission. Despite this empowering message, there are no clinical practice guidelines that focus primarily on lifestyle interventions as first-line management of prediabetes and T2D. Our objective, therefore, is to offer pragmatic, trustworthy, and evidence-based guidance for clinicians in using the 6 pillars of lifestyle medicine—nutrition, physical activity, stress management, sleep, social connectedness, avoidance of risky substances—for managing adults with T2D and in preventing T2D in adults with prediabetes or a history of gestational diabetes mellitus.

Methods: We used well-established, peer-reviewed guideline methodology to develop evidencebased key action statements (recommendations) that facilitate quality improvement in clinical practice. The guideline development group included 20 members representing consumers, advanced practice nursing, cardiology, clinical pharmacology, behavioral medicine, endocrinology, family medicine, lifestyle medicine, nutrition and dietetics, health education, health and wellness coaching, sleep medicine, sports medicine, and obesity medicine. Recommendation strength was based on the aggregate evidence supporting a key action statement plus a comparison of associated benefits vs harms/costs. Multiple literature searches, conducted by an information specialist, identified 8 relevant guidelines, 118 relevant systematic reviews, and 112 randomized clinical trials. The guideline underwent extensive internal, external, and public review and comment prior to publication.

Results: We developed 14 key action statements and associated evidence profiles, each with a distinct quality improvement goal in the context of lifestyle interventions for T2D. Strong recommendations were made regarding advocacy for lifestyle interventions; assessing baseline lifestyle habits; establishing priorities for lifestyle change; prescribing aerobic and muscle strength physical activity; reducing sedentary time; identifying sleep disorders; prescribing nutrition plans for prevention and treatment; promoting peer/familial support and social connections; counseling regarding tobacco, alcohol, and recreational drugs, and establishing clinicians and other healthcare professionals to improve quality of care for adults with, or at-risk for, T2D. Despite the research gaps and implementation challenges we highlight in the guideline we believe strongly that our recommendations have immediate relevance and can help raise awareness and shift the paradigm of T2D management towards optimal use of lifestyle interventions.

目标：糖尿病因其日益增长的患病率、与肥胖的关联以及对健康的巨大影响，已成为21世纪的一种标志性疾病。大量证据表明，生活方式干预可以延缓或预防成人2型糖尿病（T2D），提供症状缓解，有时甚至实现完全缓解。尽管这一信息极具赋能力量，但目前尚无主要侧重于将生活方式干预作为前驱糖尿病和2型糖尿病一线管理的临床实践指南。因此，我们的目标是为临床医生提供实用、可信赖且基于证据的指导，以运用生活方式医学的六大支柱——营养、身体活动、压力管理、睡眠、社会连接、避免危险物质——来管理成人2型糖尿病患者，以及预防患有前驱糖尿病或有妊娠期糖尿病（GDM）史的成人发生2型糖尿病。

方法：我们采用完善的、经过同行评审的指南制定方法，制定了基于证据的关键行动声明（建议），以促进临床实践质量的提升。指南制定小组由20名成员组成，代表消费者、高级实践护理、心脏病学、临床药理学、行为医学、内分泌学、家庭医学、生活方式医学、营养与饮食学、健康教育、健康与保健辅导、睡眠医学、运动医学和肥胖医学。建议的强度基于支持关键行动声明的总体证据以及对相关益处与危害/成本的比较。由信息专员进行的多次文献检索，确定了8份相关指南、118篇相关系统评价和112项随机临床试验。该指南在发布前经过了广泛的内部、外部和公众评审及评议。

结果：我们制定了14项关键行动声明及相关证据概要，每项声明在2型糖尿病生活方式干预的背景下都设有一个明确的质量改进目标。我们提出了以下方面的强有力建议：倡导生活方式干预；评估基线生活习惯；确立生活方式改变的优先事项；处方有氧运动和肌肉力量训练；减少久坐时间；识别睡眠障碍；为预防和治疗制定营养方案；促进同伴/家庭支持和社会连接；就烟草、酒精和消遣性药物进行咨询；以及建立临床医生和其他医疗保健专业人员团队，以改善成人2型糖尿病患者或有2型糖尿病风险人群的护理质量。

尽管我们在指南中强调了研究空白和实施挑战，但我们坚定地认为，我们的建议具有即时相关性，能够帮助提高认识，并将2型糖尿病的管理模式转向最佳利用生活方式干预。

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