Long-term Sustainability of Diabetes Prevention Approaches: A Systematic Review and Meta-analysis of Randomized Clinical Trials.
J. Sonya Haw,Karla I. Galaviz,Audrey Straus,Alysse J. Kowalski,Matthew J. Magee,Mary Beth Weber,Jingkai Wei,K.M. Venkat Narayan,Mohammed K. Ali +8 more
TLDR
In adults at risk for diabetes, LSM and medications (weight loss and insulin-sensitizing agents) successfully reduced diabetes incidence, suggesting that interventions to preserve effects are needed.Abstract:
Importance Diabetes prevention is imperative to slow worldwide growth of diabetes-related morbidity and mortality. Yet the long-term efficacy of prevention strategies remains unknown. Objective To estimate aggregate long-term effects of different diabetes prevention strategies on diabetes incidence. Data Sources Systematic searches of MEDLINE, EMBASE, Cochrane Library, and Web of Science databases. The initial search was conducted on January 14, 2014, and was updated on February 20, 2015. Search terms included prediabetes , primary prevention , and risk reduction . Study Selection Eligible randomized clinical trials evaluated lifestyle modification (LSM) and medication interventions (>6 months) for diabetes prevention in adults (age ≥18 years) at risk for diabetes, reporting between-group differences in diabetes incidence, published between January 1, 1990, and January 1, 2015. Studies testing alternative therapies and bariatric surgery, as well as those involving participants with gestational diabetes, type 1 or 2 diabetes, and metabolic syndrome, were excluded. Data Extraction and Synthesis Reviewers extracted the number of diabetes cases at the end of active intervention in treatment and control groups. Random-effects meta-analyses were used to obtain pooled relative risks (RRs), and reported incidence rates were used to compute pooled risk differences (RDs). Main Outcomes and Measures The main outcome was aggregate RRs of diabetes in treatment vs control participants. Treatment subtypes (ie, LSM components, medication classes) were stratified. To estimate sustainability, post-washout and follow-up RRs for medications and LSM interventions, respectively, were examined. Results Forty-three studies were included and pooled in meta-analysis (49 029 participants; mean [SD] age, 57.3 [8.7] years; 48.0% [n = 23 549] men): 19 tested medications; 19 evaluated LSM, and 5 tested combined medications and LSM. At the end of the active intervention (range, 0.5-6.3 years), LSM was associated with an RR reduction of 39% (RR, 0.61; 95% CI, 0.54-0.68), and medications were associated with an RR reduction of 36% (RR, 0.64; 95% CI, 0.54-0.76). The observed RD for LSM and medication studies was 4.0 (95% CI, 1.8-6.3) cases per 100 person-years or a number-needed-to-treat of 25. At the end of the washout or follow-up periods, LSM studies (mean follow-up, 7.2 years; range, 5.7-9.4 years) achieved an RR reduction of 28% (RR, 0.72; 95% CI, 0.60-0.86); medication studies (mean follow-up, 17 weeks; range, 2-52 weeks) showed no sustained RR reduction (RR, 0.95; 95% CI, 0.79-1.14). Conclusions and Relevance In adults at risk for diabetes, LSM and medications (weight loss and insulin-sensitizing agents) successfully reduced diabetes incidence. Medication effects were short lived. The LSM interventions were sustained for several years; however, their effects declined with time, suggesting that interventions to preserve effects are needed.read more
Citations
More filters
Journal ArticleDOI
Treatment of Diabetes in Older Adults: An Endocrine Society Clinical Practice Guideline
Derek LeRoith,Geert Jan Biessels,Susan S Braithwaite,Susan S Braithwaite,Felipe F. Casanueva,Boris Draznin,Jeffrey B. Halter,Jeffrey B. Halter,Irl B. Hirsch,Marie E. McDonnell,Mark E. Molitch,M. Hassan Murad,Alan J Sinclair +12 more
TL;DR: This guideline is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.
Journal ArticleDOI
Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis.
Matti Uusitupa,Tauseef Khan,Tauseef Khan,Effie Viguiliouk,Hana Kahleova,Angela A. Rivellese,Kjeld Hermansen,Andreas Pfeiffer,Anastasia Thanopoulou,Jordi Salas-Salvadó,Jordi Salas-Salvadó,Ursula Schwab,John L. Sievenpiper +12 more
TL;DR: It is concluded that T2D is preventable by changing lifestyle and the risk reduction is sustained for many years after the active intervention (high certainty of evidence).
Journal ArticleDOI
Precision Medicine in Diabetes: A Consensus Report From the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)
Wendy K. Chung,Karel A. Erion,Jose C. Florez,Andrew T. Hattersley,Marie-France Hivert,Christine G. Lee,Mark I. McCarthy,John J. Nolan,Jill M. Norris,Ewan R. Pearson,Louis H. Philipson,Allison T. McElvaine,William T. Cefalu,Stephen S. Rich,Paul W. Franks +14 more
TL;DR: This Consensus Report describes a foundation for precision diabetes medicine, while highlighting what remains to be done to realize its potential, to provide a roadmap for precision medicine in diabetes that helps improve the quality of life for all those with diabetes.
Journal ArticleDOI
Global Diabetes Prevention Interventions: A Systematic Review and Network Meta-analysis of the Real-World Impact on Incidence, Weight, and Glucose
Karla I. Galaviz,Mary Beth Weber,Audrey Straus,Jeehea Sonya Haw,K.M. Venkat Narayan,Mohammed K. Ali +5 more
TL;DR: Real-world LSM strategies can reduce diabetes risk, even with small weight reductions, in real-world populations targeting high-risk populations in one parsimonious model.
Journal ArticleDOI
Global Updates on Cardiovascular Disease Mortality Trends and Attribution of Traditional Risk Factors
TL;DR: Among the various traditional risk factors, high systolic blood pressure, unhealthy diet, high fasting plasma glucose, and high low-density lipoprotein levels were attributed to most of the CVD death and disability-adjusted life year lost.
References
More filters
Journal ArticleDOI
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
TL;DR: Moher et al. as mentioned in this paper introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses, which is used in this paper.
Journal ArticleDOI
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
TL;DR: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) is introduced, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses.
Journal ArticleDOI
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
William C. Knowler,Elizabeth Barrett-Connor,Sarah E. Fowler,Richard F. Hamman,John M. Lachin,Elizabeth A. Walker,David M. Nathan +6 more
TL;DR: In this paper, the authors compared a lifestyle intervention with metformin to prevent or delay the development of Type 2 diabetes in nondiabetic individuals. And they found that the lifestyle intervention was significantly more effective than the medication.
Journal ArticleDOI
Assessing the quality of reports of randomized clinical trials : is blinding necessary?
Alejandro R. Jadad,R. A. Moore,Dawn Carroll,C. Jenkinson,David Reynolds,David J. Gavaghan,Henry J McQuay +6 more
TL;DR: An instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research is described and its use to determine the effect of rater blinding on the assessments of quality is described.
Journal ArticleDOI
Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
K. G. M. M. Alberti,Paul Zimmet +1 more
TL;DR: A WHO Consultation has taken place in parallel with a report by an American Diabetes Association Expert Committee to re‐examine diagnostic criteria and classification of diabetes mellitus and is hoped that the new classification will allow better classification of individuals and lead to fewer therapeutic misjudgements.