Effects of lifestyle changes on adults with prediabetes: A systematic review and meta-analysis

Anna Glechner; Lina Keuchel; Lisa Affengruber; Viktoria Titscher; Isolde Sommer; Nina Matyas; Gernot Wagner; Christina Kien; Irma Klerings; Gerald Gartlehner

doi:10.1016/j.pcd.2018.07.003

Effects of lifestyle changes on adults with prediabetes: A systematic review and meta-analysis

Prim Care Diabetes. 2018 Oct;12(5):393-408. doi: 10.1016/j.pcd.2018.07.003. Epub 2018 Aug 1.

Authors

Affiliations

¹ Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria. Electronic address: anna.glechner@donau-uni.ac.at.
² Private Contribution, Munich, Germany.
³ Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria.
⁴ Danube University Krems, Department for Evidence-based Medicine and Clinical Epidemiology, Austria; Research Triangle Institute (RTI) International, USA.

PMID: 30076075
DOI: 10.1016/j.pcd.2018.07.003

Abstract

Aims: To assess the efficacy, safety, and cost-effectiveness of lifestyle intervention, compared with treatment as usual in people with prediabetes as defined by the American Diabetes Association. For older studies, we used the 1985 World Health Organization definition.

Methods: We systematically searched multiple electronic databases and referenced lists of pertinent review articles from January 1980 through November 2015. We performed an update search in MEDLINE on April 26, 2017. Based on a priori established eligibility criteria, we dually reviewed the literature, extracted data, and rated the risk of bias of included studies with validated checklists. To assess the efficacy of lifestyle intervention to prevent or delay further progression to type 2 diabetes, we conducted a random-effects meta-analysis. We assessed the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

Result: Pooled results of 16 randomized controlled trials showed that people with prediabetes who received lifestyle intervention had a lower rate of progression to type 2 diabetes after one (4% vs. 10%, RR 0.46 [CI 0.32, 0.66]) and three years of follow-up (14% vs. 23%, RR 0.64 [95% CI 0.53, 0.77]). The majority of the studies also showed a greater weight loss in lifestyle intervention participants, with a great variation between studies. Costs per quality-adjusted life-year were lower when the benefits of lifestyle intervention were analyzed over a lifelong time horizon compared to only the period of lifestyle intervention (three years) or to modeling over a ten-year period.

Conclusion: Lifestyle intervention is an efficacious, safe, and cost-effective measure to reduce the risk of progression to type 2 diabetes in people diagnosed with prediabetes. More research is necessary to compare the efficacy of various modes, frequencies, and intensities of lifestyle intervention across studies.

Keywords: Cost-effectiveness; Diabetes prevention; Lifestyle intervention; Meta-analysis; Prediabetes; Systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Aged
Aged, 80 and over
Cost-Benefit Analysis
Diabetes Mellitus, Type 2 / diagnosis
Diabetes Mellitus, Type 2 / economics
Diabetes Mellitus, Type 2 / epidemiology
Diabetes Mellitus, Type 2 / prevention & control*
Disease Progression
Female
Health Care Costs
Humans
Incidence
Male
Middle Aged
Prediabetic State / diagnosis
Prediabetic State / economics
Prediabetic State / epidemiology
Prediabetic State / therapy*
Primary Prevention / economics
Primary Prevention / methods*
Protective Factors
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Risk Reduction Behavior*
Time Factors
Treatment Outcome