Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews

Abstract

ObjectivesTo review the clinical outcomes of combined diet and physical activity interventions for populations at high risk of type 2 diabetes.DesignOverview of systematic reviews (search dates April–December 2015).SettingAny level of care; no geographical restriction.ParticipantsAdults at high risk of diabetes (as per measures of glycaemia, risk assessment or presence of risk factors).InterventionsCombined diet and physical activity interventions including ≥2 interactions with a healthcare professional, and ≥12 months follow-up.Outcome measuresPrimary: glycaemia, diabetes incidence. Secondary: behaviour change, measures of adiposity, vascular disease and mortality.Results19 recent reviews were identified for inclusion; 5 with AMSTAR scores <8. Most considered only randomised controlled trials (RCTs), and RCTs were the major data source in the remainder. Five trials were included in most reviews. Almost all analyses reported that interventions were associated with net reductions in diabetes incidence, measures of glycaemia and adiposity, at follow-up durations of up to 23 years (typically <6). Small effect sizes and potentially transient effect were reported in some studies, and some reviewers noted that durability of intervention impact was potentially sensitive to duration of intervention and adherence to behaviour change. Behaviour change, vascular disease and mortality outcome data were infrequently reported, and evidence of the impact of intervention on these outcomes was minimal. Evidence for age effect was mixed, and sex and ethnicity effect were little considered.ConclusionsRelatively long-duration lifestyle interventions can limit or delay progression to diabetes under trial conditions. However, outcomes from more time-limited interventions, and those applied in routine clinical settings, appear more variable, in keeping with the findings of recent pragmatic trials. There is little evidence of intervention impact on vascular outcomes or mortality end points in any context. ‘Real-world’ implementation of lifestyle interventions for diabetes prevention may be expected to lead to modest outcomes.

Physical Activity and Improvement of Glycemia in Prediabetes by Different Diagnostic Criteria

“…An interesting finding from our study was that TPA was particularly important for older women with i-IFG or i-IGT in terms of normalizing their blood glucose levels. A number of studies examining the effect of different lifestyle interventions on diabetes prevention in individuals with prediabetes have studied whether the effect of the various interventions differ across sex and age in subgroup analyses ( 33 ). Most intervention studies found no sex differences in the effect of lifestyle interventions on diabetes prevention or changes in glycemic parameters in individuals with prediabetes ( 33 , 34 ), potentially because they were underpowered to look at those interactions or because higher order interactions with other parameters ( e.g.…”

Association between full monitoring of biomedical and lifestyle target indicators and HbA1clevel in primary type 2 diabetes care: an observational cohort study (ELZHA-cohort 1)

“…Type 2 diabetes mellitus (T2DM) is a typical lifestyle-related disease 1. The course of T2DM and potential complications are influenced by smoking behaviour,2 3 BMI4 and physical exercise 5.…”

Implementation of the DP-Transfers Project in Catalonia—A Translational Method to Improve Diabetes Screening and Prevention in Primary Care

“…Preventing or delaying diabetes incidence has become a real challenge in all public health systems [1]. The efficacy of clinical trials on lifestyle interventions for diabetes prevention has been wellestablished [2,3], and efforts to translate these interventions to primary care settings have shown promising results [4][5][6]. Long-term projections have also shown that diabetes can be postponed by an average of 5 years in people who already have pre-diabetes [7].…”

“…An additional reason might be that translation channels do not work properly. In all, this could result in an increase of the consequences of diabetes, a waste of public resources and a loss of potential health benefits [5,8].…”