Global Diabetes Prevention Interventions: A Systematic Review and Network Meta-analysis of the Real-World Impact on Incidence, Weight, and Glucose

Galavíz, Karla I.; Weber, Mary Beth; Straus, Audrey; Haw, J. Sonya; Narayan, K.M. Venkat; Ali, Mohammed K.

doi:10.2337/dc17-2222

Cited by 175 publications

(161 citation statements)

References 43 publications

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“…Of note, the absolute benefit on diabetes prevention was higher in our study than in this meta-analysis (7.4% vs 4.0%, respectively) and so the NNT was lower (14 vs 25) [13]. Our findings compare well with the first efficacy studies, reporting 6.2-12% absolute risk reductions (NNT 16-8, respectively) [8,9], but are somewhat stronger than those of a meta-analysis of translational studies to prevent diabetes in high-risk populations other than South Asians (RR reduction, 29%; absolute risk reduction, 3%) [14].…”

Section: Discussionsupporting

confidence: 82%

“…From 2001, efficacy trials have documented a reduction in diabetes incidence in high-risk adults of up to 58% through lifestyle modification interventions incorporating a healthy diet and/or physical activity [8][9][10][11][12]. Recent meta-analyses of efficacy and pragmatic diabetes prevention trials found a 30-40% reduction in diabetes incidence [13,14]. However, none of these meta-analyses reported effects specifically for South Asians [13,14], although several lifestyle intervention trials, culturally adapted to suit the specific needs, cultural norms and values of the South Asian populations in different contexts, have been developed and tested [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

“…Recent meta-analyses of efficacy and pragmatic diabetes prevention trials found a 30-40% reduction in diabetes incidence [13,14]. However, none of these meta-analyses reported effects specifically for South Asians [13,14], although several lifestyle intervention trials, culturally adapted to suit the specific needs, cultural norms and values of the South Asian populations in different contexts, have been developed and tested [15][16][17][18]. Some trials in South Asian populations appeared moderately successful, but the effectiveness differed across studies.…”

Section: Introductionmentioning

confidence: 99%

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Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials

et al. 2019

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Aims/hypothesis Individuals of South Asian origin have a high risk of type 2 diabetes and of dying from a diabetes-attributable cause. Lifestyle modification intervention trials to prevent type 2 diabetes in high-risk South Asian adults have suggested more modest effects than in European-origin populations. The strength of the evidence of individual studies is limited, however. We performed an individual participant data meta-analysis of available RCTs to assess the effectiveness of lifestyle modification in South Asian populations worldwide. Methods We searched PubMed, EMBASE, Cochrane Library and Web of Science (to 24 September 2018) for RCTs on lifestyle modification interventions incorporating diet and/or physical activity in South Asian adults. Reviewers identified eligible studies and assessed the quality of the evidence. We obtained individual participant data on 1816 participants from all six eligible trials (four from Europe and two from India). We generated HR estimates for incident diabetes (primary outcome) and mean differences for fasting glucose, 2 h glucose, weight and waist circumference (secondary outcomes) using mixed-effect meta-analysis overall and by pre-specified subgroups. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence of the estimates. The study is registered with the International Prospective Register of Systematic Reviews ([PROSPERO] CRD42017078003). Results Incident diabetes was observed in 12.6% of participants in the intervention groups and in 20.0% of participants in the control groups. The pooled HR for diabetes incidence was 0.65 (95% CI 0.51, 0.81; I 2 = 0%) in intervention compared with Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00125-019-4905-2) contains peer-reviewed but unedited supplementary material, which is available to authorised users. control groups. The absolute risk reduction was 7.4% (95% CI 4.0, 10.2), with no interactions for the pre-specified subgroups (sex, BMI, age, study duration and region where studies were performed). The quality of evidence was rated as moderate. Mean difference for lifestyle modification vs control groups for 2 h glucose was −0.34 mmol/l (95% CI −0.62, −0.07; I 2 = 50%); for weight −0.75 kg (95% CI −1.34, −0.17; I 2 = 71%) and for waist −1.16 cm (95% CI −2.16, −0.16; I 2 = 75%). No effect was found for fasting glucose. Findings were similar across subgroups, except for weight for European vs Indian studies (−1.10 kg vs −0.08 kg, p = 0.02 for interaction). Conclusions/interpretation Despite modest changes for adiposity, lifestyle modification interventions in high-risk South Asian populations resulted in a clinically important 35% relative reduction in diabetes incidence, consistent across subgroups. If implemented on a large scale, lifestyle modification interventions in high-risk South Asian populations in Europe would reduce the incidence of diabetes in these populations.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials

et al. 2019

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“…A meta-analysis of 63 studies showed that each additional kilogram loss induced by lifestyle interventions was associated with 43% lower odds of type 2 DM. 121 Caloric restriction without malnutrition leads to increased longevity and delayed onset of age-associated disorders in rhesus monkeys. 122 Nutrition Fatty acids and carbohydrate intake.…”

Section: Body Weightmentioning

confidence: 99%

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

Piepoli

Abreu

Albus

et al. 2019

Eur J Prev Cardiolog

168

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European guidelines on cardiovascular prevention in clinical practice were first published in 1994 and have been regularly updated, most recently in 2016, by the Sixth European Joint Task Force. Given the amount of new information that has become available since then, components from the task force and experts from the European Association of Preventive Cardiology of the European Society of Cardiology were invited to provide a summary and critical review of the most important new studies and evidence since the latest guidelines were published. The structure of the document follows that of the previous document and has six parts: Introduction (epidemiology and cost effectiveness); Cardiovascular risk; How to intervene at the population level; How to intervene at the individual level; Disease-specific interventions; and Settings: where to intervene? In fact, in keeping with the guidelines, greater emphasis has been put on a population-based approach and on disease-specific interventions, avoiding re-interpretation of information already and previously considered. Finally, the presence of several gaps in the knowledge is highlighted.

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“…prevention of type 2 diabetes in routine practice have demonstrated relative risk reductions in incidence of 26% and 29% (4)(5)(6).…”

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confidence: 99%

Early Outcomes From the English National Health Service Diabetes Prevention Programme

Valabhji

Barron

Bradley³

et al. 2019

Diabetes Care

120

182

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To assess weight and HbA 1c changes in the Healthier You: National Health Service Diabetes Prevention Programme (NHS DPP), the largest DPP globally to achieve universal population coverage. RESEARCH DESIGN AND METHODS A service evaluation assessed intervention effectiveness for adults with nondiabetic hyperglycemia (HbA 1c 42-47 mmol/mol [6.0-6.4%] or fasting plasma glucose 5.5-6.9 mmol/L) between program launch in June 2016 and December 2018, using prospectively collected, national service-level data in England.

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Global Diabetes Prevention Interventions: A Systematic Review and Network Meta-analysis of the Real-World Impact on Incidence, Weight, and Glucose

Abstract: Real-world LSM strategies can reduce diabetes risk, even with small weight reductions.

Cited by 175 publications

References 43 publications

Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials

Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

Early Outcomes From the English National Health Service Diabetes Prevention Programme

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