Effects Of Internet + Team Weight Intensive Management On Weight Loss And Endocrine Metabolism In Overweight/Obesity Patients

BackgroundWith the rapid economic development and the changes of lifestyle,the worldwide prevalence of overweight and obesity has increased dramatically,and the incidence of obesity-related chronic metabolic diseases has risen constantly.Exploring effective and safe weight management methods have become a public concern and a research hotspot for scholars.Although there are many ways to treat obesity,lifestyle intervention is currently considered to be the most critical,safe and effective method of weight management.However,traditional lifestyle intervention is limited to the guidance of hospital specialists.It is difficult for patients to continue to receive corresponding professional support after leaving the hospital.The compliance and execution of insisting on treatment are insufficient,which seriously affect the treatment effect of weight loss.With the increasing popularity of the use of the internet,people’s information exchange has been accelerated.In recent years,the Department of Endocrinology of our hospital has opened an obesity clinic and used the internet to carry out team weight intensive management.This study retrospectively analyzed the case data since the beginning of obesity clinics,in order to sum up experience and promote future work.Objective1.To evaluate the effects of‘Internet + Team Weight Intensive Management’on weight loss and endocrine metabolism in overweight or obese patients at different times.2.To assess the effects of weight intensive management on obesity-related metabolic diseases including type 2 diabetes mellitus,hyperlipidemia,hyperuricemia,metabolic syndrome,and nonalcoholic fatty liver disease(NAFLD).3.To evaluate the effects of intensive lifestyle intervention or exenatide treatment on weight loss and endocrine metabolism in overweight or obese PCOS patients.MethodsA total of 245 participants who were accepted weight intensive management with age 20 to 65 years and overweight/obese were enrolled from outpatient endocrinology clinics at the Third Affiliated Hospital of Guangzhou Medical University during May 2017 to March 2019.There were 160 cases with complete data and compliance of more than 80%.According to the intervention time,participants were divided into group A,B and C,which represented the intervention time for one month,two months and three months respectively.This study was a self-control study before and after intervention.Anthropometric parameters(body weight,waist circumference,hip circumference),body composition(body mass rate,body mass,visceral fat area,muscle mass),insulin levels,glycolipid metabolism,liver and renal function(alanine aminotransferase,aspartate transaminase,Crea),Uric acid level as well as inflammatory level(high-sensitivity C-reactive protein)were measured before and after intervention.Testosterone in patients with PCOS were measured,and diabetic patients measured glycosylated hemoglobin(HbAlc)before and 3 months after intervention.Body mass index(BMI),steady-state model insulin resistance index(HOMA-IR)and insulin sensitivity index(ISI)were calculated and to observe the incidence of hyperlipidemia,hyperuricemia,diabetes mmellitus,metabolic syndrome,abnormal liver function before and after intervention.SPSS 24.0 software was used for statistical analysis.Then,a total of 50 PCOS patients aged 20~40 years old were selected from the group B and C as the intensive lifestyle intervention group(ILI group),and 50 overweight/obese PCOS patients with age-and BMI-matched and treated with exenatide for three months were randomly selected from the preclinical study(Chinese clinical trial registration number: ChiCTR-IIR-16008084)as control group(EXE group).Body weight,waist circumference(WC),insulin levels,glycolipid metabolism,liver function,inflammatory level(high-sensitivity C-reactive protein,hs-CRP)and uric acid(UA)level were measured before and after treatment.BMI,HOMA-IR,ISI were calculated.Then to evaluate the effects on the above parameters within the group and between two groups.Results1.Compared with pre-intervention,body weight,BMI,WC,body mass rate(BMR),body fat mass(BFM)and visceral fat area(VFA)of overweight/obese patients at different times were significantly decreased(P<0.05).After intervention,fasting blood glucose(FBG),2 hours postglucose load blood glucose(2hPBG),fasting insulin(FINS),2 hours postglucose load blood insulin(2hINS)and HOMA-IR decreased significantly(P<0.05),and ISI was significantly increased than before intervention(P<0.05).The levels of total cholesterol(TC),triglyceride(TG)and low density lipopretein cholesterol(LDL-C)in group A and group B were significantly lower than those in baseline(P<0.05).The TG,LDL-C level in group C was significantly lower than baseline(P<0.05),while there were no statistically different in TC level(P<0.05).Compared with before intervention,the levels of ALT,AST,UA in three groups decreased significantly after intervention(P<0.05).63.3% of patients could reduce the initial body weight by more than 5% after one-month intervention;Almost all the patients could achieve this goal in 2 months,more than half of the patients could reduce the initial body weight by more than 10%;all patients could reduce the initial body weight by more than 5% after 3-months intervention,and nearly half of patients could reduce the initial body weight by more than 15%.Through short-term weight intensive management,the average weight of patients with type 2 diabetes decreased by 8.31±4.79% of the initial body weight.The rate of reaching standard of HbAlc raised to 93.2% from 47.7%.HbAlc level and the risk of ischemic cardiovascular disease in 10 years decreased significantly(P<0.05).50.0% of diabetic patients changed to normal glucose tolerance,and 45.5% of patients converted to impaired glucose tolerance.After the intervention,the incidence of hyperlipidemia,hyperuricemia,abnormal liver function,insulin resistance and metabolic syndrome decreased significantly(P<0.05).2.After an intensive lifestyle intervention or exenatide treament,ILI group had an average weight-loss of 10.02±3.6 kg and EXE group had lost an average weight of 6.15±2.28 kg,both significantly reduced than baseline(P<0.05),the difference between two groups was also statistically significant(P<0.05).The BMI and WC after intervention in two groups were significantly lower than baseline,and the differences between two groups were statistically significant(P<0.05).FBG,2hPBG,FINS,2hINS and HOMA-IR after intervention in ILI group were significantly lower than before intervention,and ISI was significantly higher than before intervention(P<0.05).In EXE group,there was no significantly difference in FBG beween before and after treatment(P>0.05),while 2hPBG,FINS,2hINS,HOMA-IR after treatment had statistically lower than before treatment(P<0.05),ISI was significantly higher than before treatment(P < 0.05).There was no difference in the improvement of 2hPBG and 2hINS between the two groups(P>0.05).In both groups,hs-CRP level after intervention was significantly lower than baseline(P<0.05),but there was no significant difference between two groups(P>0.05).The TC,TG and LDL-C of two groups were significantly lower than baseline(P<0.05).The improvement of TG in ILI group was better than that in the EXE group(P<0.05).In EXE group,LDL-C was significantly lower than before intervention(P<0.05),but TC and TG had no significant difference between before and after treatment(P>0.05).The improvement of TG in ILI group was better than EXE group while the improvement of TC and LDL-C were equivalent.The levels of ALT and AST in two group were significantly lower than those in the baseline(P<0.05),but there was no statistical difference between ILI group and EXE group(P>0.05).The UA level in two groups was significantly lower than baseline(P<0.05),and the improvement of UA in ILI group was better than that EXE group(P<0.05).The levels of testosterone in both groups were significantly decrease than before intervention(P<0.05),but there was no significant difference in the improvement of testosterone between two groups(P>0.05).Conclusion1.In an Internet + Team Weight Intensive Management model,short-term intervention can significantly reduce body weight,BMI,WC and BFR,BFM and VFA in in overweight/obese patients.2.After one-month weight intensive management,63.3% of patients were able to achieved clinically meanful weight reduction(more than 5% of initial body weight).More than half of the patients who were intervented for 2 months could reduce the initial weight by more than 10%.After 3-months intervention,all patients could achieve weight reduction more than 5% of the initial body weight,and nearly half of the patients can reduce the initial body weight by more than 15%.3.Short-term weight intensive management can significantly improve insulin resistance,glycolipid metabolism,liver function,and uric acid levels,thereby significantly reducing the incidence of obesity complications including hyperlipidemia,hyperuricemia,insulin resistance,metabolic syndrome,and nonalcoholic fatty liver disease.93.2% of patients with type 2 diabetes achieved glycemic control,45.5% achieved reversal to IGT status,and 50.0% reversed to NGT status.4.Intensive lifestyle intervention or exenatide treatment can reduce weight,BMI and improve central obesity in overweight/obese PCOS patients.Intensive lifestyle intervention can effectively control fasting blood glucose,improve insulin resistance,and lower insulin levels,and its effects were better than exenatide treatment.Intensive lifestyle interventions or exenatide treatment could reduce testosterone levels and improve inflammatory conditions.