1. From a systematic review, diet and physical activity promotion programs were linked to decreased risk factors for diabetes, as well as incidence of new cases.
2. More intense programming was associated with better outcomes.
Evidence Rating Level: 1 (Excellent)
Study Rundown: An estimated 1.7 million new cases of diabetes are diagnosed yearly, making it a growing medical problem in the US. Without intervention, 5-10% of persons with pre-diabetes will progress to type 2 diabetes, accounting for 9 out of 10 new cases of diabetes every year. Large clinical trials have shown that weight loss and increased physical activity are important components to diabetes prevention. However, the impact and value of implementing such promotion programs is still unknown. This review assessed the effectiveness of diet and physical activity promotion programs in clinical and community settings. The relative risk for diabetes incidence was less in program participants across studies, with more intensive programs showing greater reduction. Risk factor improvement was also described, with some studies reporting upwards of 50% return to normoglycemia, as much as 10% weight loss, and decreases in blood pressure and cholesterol levels. While some studies reported trend towards decreased all-cause mortality, evidence for long-term clinical outcomes was limited, and the variability of programs restricted the identification of the features most contributory to effectiveness. Overall, the promotion of diet and physical activity may be an important factor in preventing diabetes.
In-Depth [systematic review]: This review identified 53 studies (36 RCTs, 4 prospective non-randomized comparative, and 13 prospective single group studies) describing 66 programs involving adults or children with increased risk of type 2 diabetes. Programs were required to have at least 2 contact sessions in 3 months and include dietary and physical activity components; programs could take place in any outpatient setting and provide any type of advice. A total of 16 studies comparing promotion programs and usual care reported on incidence of diabetes (summary RR 0.59; 95%CI 0.51-0.66). Five studies reported lower incidence with more intense programs (RR 0.28-0.56), but this was only statistically significant in 1 study. Four studies produced a summary RR for achievement of normoglycemia at 3 years of 1.53 (95%CI 1.26-1.71). The Da Qing study reported lower risk of all-cause mortality (HR 0.71; 95%CI 0.51-0.99), but this was restricted to women. 24 studies reporting weight change found decreases ranging between 0.2 to 10.5% (summary net change -2.2%; 95%CI -2.9 to -1.4%). A total of 18 studies reporting glycemic outcomes reported a 1 year summary net change in fasting glucose of -0.12 mmol/L (95%CI -0.20 to -0.05 mmol/L). There were 17 studies that reported 1 year improved systolic blood pressure with net change of -1.6 mmHg (95%CI -2.7 to -0.5 mmHg). Fourteen studies reported improved total cholesterol levels with net change -0.05 mmol/L (95%CI -0.12 to -0.002 mmol/L).
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