p.16 抽出テキスト

Arnett et al 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

Circulation. 2019;140:e596–e646. DOI: 10.1161/CIR.0000000000000678 September 10, 2019 e611 CLINICAL STATEMENTS AND GUIDELINES

lower likelihood of CVD events and CVD death in adults with T2DM who follow a healthy dietary pattern.S4.2-17 However, an RCT targeting aggressive lifestyle interventions in T2DM was unable to show a reduction in ASCVD events despite early success in achieving weight loss.S4.2-18 The quality of carbohydrate intake is especially important for control of T2DM, and focus should be placed on the intake of fiber-rich whole grains and avoidance of refined carbohydrates.S4.2-19 Additionally, red meat consumption has been shown to increase the risk of T2DM, and decreasing intake of red meat can improve glycemic control.S4.2-20,S4.2-21 Weight loss is an essential treatment component for T2DM, and dietary recommendations should be adjusted to achieve meaningful weight loss, if needed. Establishing an appropriate nutrition plan requires time and effort and is best accomplished with assistance from a registered dietitian-nutritionist or a diabetes education program. 2.	Initiation of an exercise program for those with T2DM has been shown to improve glycemic control, with a prior meta-analysis showing a significant reduction in mean HbA1c (7.65% versus 8.31%) in individuals assigned to an exercise program versus control groups.S4.2-22 The combination of aerobic and resistance training further improves glycemic control and facilitates weight loss more than either type of exercise alone.S4.2-3,S4.2-4 Prospective cohort studies have provided supportive data for the benefits of physical activity in individuals with T2DM, with increased levels of physical activity associated with lower rates of CVD events and CVD death.S4.2-17

How to best promote physical activity in individuals with T2DM remains unclear. For older individuals with other comorbidities, a simple walking program may be ideal, whereas for younger, healthier individuals, a variety of activities should be encouraged. In addition to a structured exercise program, a general increase in physical activity throughout the day (eg, taking the stairs, walking or biking to work, avoiding prolonged periods of sitting) should be encouraged. 3.	Metformin decreases hepatic glucose production and increases peripheral insulin sensitivity,

Figure 2. Treatment of T2DM for primary prevention of cardiovascular disease. CVD indicates cardiovascular disease; GLP-1R, glucagon-like peptide-1 receptor; HbA1c, hemoglobin A1c; SGLT-2, sodium-glucose cotransporter 2; and T2DM, type 2 diabetes mellitus.

Downloaded from http://ahajournals.org by on October 7, 2026