1. In this meta-analysis of studies that evaluated the rate of diabetes development in high risk individuals, lifestyle modifications (LSM) and certain classes of medications were found to be effective at reducing risk.
2. Lifestyle modifications demonstrated a persistent effect on risk reduction for diabetes, while the observed effects from medications were short-lived.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Diabetes mellitus (DM) continues to be a growing health concern for many nations with significant associated morbidity and mortality. Many individuals can be identified as high risk for the development of diabetes and there has been much focus on strategies to reduce this risk. This study is a systematic review and meta-analysis of different interventions aimed at reducing the rate of diabetes in high risk individuals, and evaluated the short- and long-term effectiveness of those interventions. The study found that lifestyle interventions, including dietary changes and increased activity, demonstrated reduction in the risk of DM in both short- and long-term follow up. Medications including insulin sensitizers, and weight loss medications demonstrated comparable reduction in short-term risk of DM, but not in the long-term.
The observed long-term benefits of lifestyle interventions over the more short-term effects of medications may help inform policy and funding strategies aimed at reducing overall burden of DM. The study is methodologically rigorous and evaluates many studies. The main limitations include the high heterogeneity of treatment effects, and pooling of patients with both impaired fasting glucose, and impaired glucose tolerance.
In-Depth [systematic review and meta-analysis]: This study is a meta-analysis of investigations from 1990 to 2015 that evaluated the effect of lifestyle and/or medication interventions on DM risk in patients with “prediabetes” defined with either impaired glucose tolerance, and/or impaired fasting glucose. Studies that included patients with established type 1 or 2 diabetes, or gestational diabetes were excluded. Studies that evaluated surgical interventions such as gastric bypass were also excluded.
The 43 studies encompassed 49 029 participants, with 19 studies of medications, 19 of lifestyle modifications (LSM), and 5 evaluating a combination approach. LSM was associated with a relative risk reduction of developing diabetes of 39% in the short-term follow up (RR, 0.61; 95%CI, 0.54-0.68) and 28% in the long-term (mean follow up of 7.2 years) (RR, 0.72; 95%CI, 0.60-0.86). Medications had a short-term risk reduction of 36% (RR, 0.64; 95%CI, 0.54-0.76) but no sustained response in long-term follow up. The most active medications included insulin sensitizing agents (metformin, rosiglitazone, and pioglitazone), and weight loss agents (orlistat, combination phentermine-topiramate). Angiotensin receptor blockers and α-Glucosidase inhibitors showed lower or more heterogeneous efficacy.
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