追加：第 2 节第 45 条，查出糖尿病前期就靠少吃、减重、多动把糖尿病往后推

2026-10-14。和第 1 节第 8 条（35 岁以后超重就查空腹血糖）分工：那一条管怎么查出来，这一条管查出来以后做什么。追加在第 2 节末尾，条号先占 45。全书原来只有第 1 节第 8 条备注里一句「相当一部分人光靠改生活方式就能把它扭回去」，没有数字，不算重复。

证据等级与收益量级

  • 证据等级 A：三项随机分组试验（大庆、美国 DPP、芬兰 DPS），都能给出具体的风险比。
  • 标「争议」：只有大庆看到总死亡率下降。DPP 跟到中位 21 年总死亡 HR 1.02 不显著，DPS 跟到平均 10.6 年总死亡 HR 0.57（0.21–1.58）不显著。这两项作为反方写进收益栏，来源栏标「争议方」。
  • 收益量级「大」：按死亡率口径机械套，大庆 30 年总死亡 HR 0.74，相对降约 26%，过了 20% 的线。备注里写明美国和芬兰没有重复出来。
  • 成本标签：钱=0；时间=多，和本节第 11 条、第 32 条一致（每天都要动、每顿都要管）；毅力=是。
  • 人群标签：不加。糖尿病前期是一种身体状况，不在 7 个值里，按规则同慢病一样不加。
  • 标题写的是「把糖尿病往后推」而不是「扭回去」：三项试验的主要终点都是得不得糖尿病、什么时候得，没有一项以「血糖回到正常」为主要终点。

1. Pan XR 等 (1997)，大庆研究原始报告

  • DOI：https://doi.org/10.2337/diacare.20.4.537（Europe PMC 摘要，PMID 9096977）
  • 原文：「Of these individuals, 577 were classified (using World Health Organization criteria) as having IGT. Subjects were randomized by clinic into a clinical trial, either to a control group or to one of three active treatment groups: diet only, exercise only, or diet plus exercise.」
  • 原文：「The cumulative incidence of diabetes at 6 years was 67.7% (95% CI, 59.8-75.2) in the control group compared with 43.8% (95% CI, 35.5-52.3) in the diet group, 41.1% (95% CI, 33.4-49.4) in the exercise group, and 46.0% (95% CI, 37.3-54.7) in the diet-plus-exercise group (P < 0.05).」
  • 原文：「The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight (BMI < or > or = 25 kg/m2).」
  • 原文：「In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose, the diet, exercise, and diet-plus-exercise interventions were associated with 31% (P < 0.03), 46% (P < 0.0005), and 42% (P < 0.005) reductions in risk of developing diabetes, respectively.」

2. Li G 等 (2014)，大庆 23 年随访

  • DOI：https://doi.org/10.1016/S2213-8587(14)70057-9（Europe PMC 摘要，PMID 24731674）
  • 原文：「Cumulative incidence of cardiovascular disease mortality was 11.9% (95% CI 8.8-15.0) in the intervention group versus 19.6% (12.9-26.3) in the control group (hazard ratio [HR] 0.59, 95% CI 0.36-0.96; p=0.033). All-cause mortality was 28.1% (95% CI 23.9-32.4) versus 38.4% (30.3-46.5; HR 0.71, 95% CI 0.51-0.99; p=0.049). Incidence of diabetes was 72.6% (68.4-76.8) versus 89.9% (84.9-94.9; HR 0.55, 95% CI 0.40-0.76; p=0.001).」

3. Gong Q 等 (2019)，大庆 30 年随访

  • DOI：https://doi.org/10.1016/S2213-8587(19)30093-2；全文在 PMC8172050（https://pmc.ncbi.nlm.nih.gov/articles/PMC8172050/，带代理取到；Europe PMC 的 fullTextXML 接口返回 500）
  • 原文：「compared with control, the combined intervention group had a median delay in diabetes onset of 3·96 years (95% CI 1·25 to 6·67; p=0·0042), fewer cardiovascular disease events (hazard ratio 0·74, 95% CI 0·59-0·92; p=0·0060), a lower incidence of microvascular complications (0·65, 0·45-0·95; p=0·025), fewer cardiovascular disease deaths (0·67, 0·48-0·94; p=0·022), fewer all-cause deaths (0·74, 0·61-0·89; p=0·0015), and an average increase in life expectancy of 1·44 years (95% CI 0·20-2·68; p=0·023).」
  • 小血管并发症的定义（正文方法部分）：「The primary outcome of composite microvascular disease was an aggregate outcome of retinopathy, defined as a history of photocoagulation, blindness from retinal disease, or proliferative retinopathy; nephropathy, defined as a history of end-stage renal disease, renal dialysis, renal transplantation, or death from chronic kidney disease; and neuropathy, defined as a history of leg, ankle, or foot ulceration, gangrene, or amputation.」都是重的结局（失明、透析、腿脚溃烂截肢一类），所以条目写「眼底、肾、神经的严重小血管并发症」。
  • 局限（正文讨论部分）：「First, the sample size is small because the original trial was designed to study diabetes incidence and not complications.」
  • 体重（正文讨论部分）：「[DPS 和 DPP] were done in people with impaired glucose tolerance with an average BMI greater than 30 kg/m2」；「In the Da Qing study, the baseline mean BMI of participants was only 25.7 kg/m2, and weight loss was encouraged only in those participants with a BMI higher than 25 kg/m2. The interventions resulted in only small changes in BMI, suggesting that the reduced diabetes incidence in the intervention group was mainly attributable to factors such as changes in dietary composition and increased physical activity rather than weight loss.」备注里「不胖的人也照样要改吃法、多动」出自这一段和 Pan 1997 的分层结果。

4. Knowler WC 等 (2002)，美国 DPP

  • DOI：https://doi.org/10.1056/NEJMoa012512（Europe PMC 摘要，PMID 11832527）
  • 原文：「We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index …… was 34.0」
  • 原文：「The average follow-up was 2.8 years.」；「The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin.」

5. DPP Research Group (2015)，DPPOS 15 年

  • DOI：https://doi.org/10.1016/S2213-8587(15)00291-0（Europe PMC 摘要，PMID 26377054）
  • 原文：「During a mean follow-up of 15 years, diabetes incidence was reduced by 27% in the lifestyle intervention group (hazard ratio 0·73, 95% CI 0·65-0·83; p<0·0001) and by 18% in the metformin group (0·82, 0·72-0·93; p=0·001), compared with the placebo group, with declining between-group differences over time.」
  • 原文：「All participants were offered lifestyle training at the end of the DPP.」

6. Lee CG 等 (2021)，DPP/DPPOS 死亡率（争议方）

  • DOI：https://doi.org/10.2337/dc21-1046（Europe PMC 摘要，PMID 34697033）
  • 原文：「Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone」
  • 原文：「Over a median of 21 years (interquartile range 20-21), 453 participants died.」；「Similarly, lifestyle modification did not impact all-cause (HR 1.02 [95% CI 0.81, 1.28]), cancer (HR 1.07 [95% CI 0.74, 1.55]), or cardiovascular disease (HR 1.18 [95% CI 0.77, 1.81]) mortality.」
  • 原文结论：「Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates.」

7. Tuomilehto J 等 (2001)，芬兰 DPS

  • DOI：https://doi.org/10.1056/NEJM200105033441801（Europe PMC 摘要，PMID 11333990）
  • 原文：「We randomly assigned 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index …… 31) with impaired glucose tolerance」
  • 原文：「The cumulative incidence of diabetes after four years was 11 percent (95 percent confidence interval, 6 to 15 percent) in the intervention group and 23 percent (95 percent confidence interval, 17 to 29 percent) in the control group. During the trial, the risk of diabetes was reduced by 58 percent (P<0.001) in the intervention group.」
  • DPS 的减重目标（体重减 5% 以上）摘要里没写，正文没取到，条目没写这个数，只写了 DPP 的 7%。

8. Lindström J 等 (2006)，DPS 延长随访

  • DOI：https://doi.org/10.1016/S0140-6736(06)69701-8（Europe PMC 摘要，PMID 17098085）
  • 原文：「After a median of 4 years of active intervention period, participants who were still free of diabetes were further followed up for a median of 3 years, with median total follow-up of 7 years.」；「During the total follow-up, the incidence of type 2 diabetes was 4.3 and 7.4 per 100 person-years in the intervention and control group, respectively (log-rank test p=0.0001), indicating 43% reduction in relative risk.」
  • 「一对一辅导」对应原文的「individual lifestyle counselling was stopped」。

9. Uusitupa M 等 (2009)，DPS 10 年死亡率（争议方）

  • DOI：https://doi.org/10.1371/journal.pone.0005656（Europe PMC 摘要，PMID 19479072）
  • 原文：「Median length of the intervention period was 4 years and the mean follow-up was 10.6 years.」；「total mortality (2.2 vs. 3.8 per 1000 person years, hazard ratio HR = 0.57, 95% CI 0.21-1.58) and cardiovascular morbidity (22.9 vs. 22.0 per 1000 person years, HR = 1.04, 95% CI 0.72-1.51) did not differ significantly between the intervention and control groups.」
  • 原文：「However, the statistical power may not be sufficient to detect small differences between the intervention and control groups.」

10. 健康中国行动（2019—2030年），（十四）糖尿病防治行动

  • URL：https://wjw.hunan.gov.cn/wjw/ztzl/knowledge/tzggzcfg/202003/t20200303_11359594.html（湖南省卫健委转载，2026-10-14 直连 200；第 2 节第 12 条用的是同一个页面）。gov.cn 原文页 content_5409694 本轮取到的是空壳，没用。
  • 定义：「6.1mmol/L≤空腹血糖(FBG)<7.0mmol/L,或7.8mmol/L≤糖负荷2小时血糖(2hPG)<11.1mmol/L,则为糖调节受损,也称糖尿病前期,属于糖尿病的极高危人群。」
  • 做法：「糖尿病前期人群可通过饮食控制和科学运动降低发病风险,建议每半年检测1次空腹血糖或餐后2小时血糖。同时密切关注其他心脑血管危险因素,并给予适当的干预措施。建议超重或肥胖者使体重指数(BMI)达到或接近24kg/㎡,或体重至少下降7%,每日饮食总热量至少减少400~500kcal,饱和脂肪酸摄入占总脂肪酸摄入的30%以下,中等强度体力活动至少保持在150分钟/周。」
  • 饱和脂肪酸那半句原文写的是「占总脂肪酸摄入的30%以下」，口径和常见写法（占总能量的百分比）不同，读者难照做，条目没收。

没收的

  • 《中国2型糖尿病防治指南（2020年版）》和《中国成人糖尿病前期干预的专家共识》：原文都在中华医学期刊网，本轮没取到全文。健康中国行动里的做法已经能逐字核对，所以没再去找。
  • DPP 的「血糖回到正常」二次分析、印度和日本的试验：主线数字够了，没再加。
  • 大庆 2016 年 Diabetes Care 那篇（进展成糖尿病的人死亡风险高 73%）：说的是得了糖尿病的后果，不是干预的效果，没用。