Non-pharmacological interventions for the prevention of type 2 diabetes mellitus in low and middle-income countries: protocol for a systematic review and meta-analysis of randomized controlled trials

Abstract

Introduction The disease burden caused by type 2 diabetes mellitus is a prime public health concern. The prevalence and rate of deaths from diabetes mellitus in low- and middle-income countries (LMICs) are higher than the high-income countries. Increased physical activity and a balanced diet are essential and successful measures to prevent the onset of diabetes mellitus. This systematic review aims to explore the available non-pharmacological approaches for the prevention of type 2 diabetes mellitus in LMICs. Methods and analysis Six online databases will be explored to get related randomized controlled trials (RCTs) published in English from inception to September 2020, and two coders will independently screen, identify studies, extract data, and assess the risk of bias in each article. The searched articles will be included by applying specific inclusion and exclusion criteria. Joanna Briggs Institute’s tool for RCTs will be used for appraising the trials critically. Narrative synthesis and pooled effect of the interventions will be demonstrated. A meta-analysis will be conducted using the random-effects model if assumptions are fulfilled. Discussion This review is an attempt to explore the available non-pharmacological approaches for the prevention of type 2 diabetes mellitus in LMICs. Findings from the review will highlight effective non-pharmacological measures for the prevention of type 2 diabetes mellitus to guide policy for future strategies. Systematic review registration The review protocol has been registered (CRD42020191507).

Non-pharmacological interventions for the prevention of type 2 diabetes in low-income and middle-income countries: a systematic review of randomised controlled trials

“…The systematic review is registered in the International Prospective Register of Systematic Reviews. The protocol outlines the approach in depth, including the development of the search strategy, double-screening, double-data extraction, double-quality assessment of included articles and narrative synthesis 27. A detailed search strategy (online supplemental table 1) was constructed using the keywords including Exercise, ‘Physical activity’, ‘Nutritional therapy’’, ‘Meal plan’, ‘Weight loss’, ‘Lifestyle change’, ‘Lifestyle modification’, Diabetes, ‘Diabetes mellitus’, ‘Type 2 diabetes mellitus’’, T2DM, DM, LMICs, ‘Developing country’, ‘Peri-urban’’, urban, rural to search different electronic bibliographic database including MEDLINE through PubMed, Embase, the Cochrane Library (Cochrane Central Register of Controlled Trials-CENTRAL), Web of Science, ClinicalTrials.gov, International Clinical Trials Registry Platform, etc.…”

Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused

“…Each kilogram of weight loss results in a 16% relative risk reduction and strongly correlates with a decreased progression to Type 2 diabetes. 14 According to a clinical investigation carried out in Da Qing, China, diet or exercise or a combination of diet and exercise was significantly linked to reductions in the probability of acquiring diabetes by 31%, 46%, and 42%, respectively. 15 People with a higher likelihood of developing diabetes should undergo more frequent screenings.…”

Insulin Resistance/Diabetes and Schizophrenia: Potential Shared Genetic Factors and Implications for Better Management of Patients with Schizophrenia

“…Consequently, it is possible that preventive measures may preclude T2D development. Accumulating evidence has demonstrated that early impaired insulin sensitivity and prediabetes can be addressed by nonpharmacological measures [62,71,72]. The latter may include reducing carbohydrate intake and increasing intake of healthy fats in combination with an anti-inflammatory diet (a dietary approach that emphasizes the consumption of foods with anti-inflammatory properties while minimizing or avoiding foods that can promote inflammation) to reduce systemic inflammation [73].…”

“…The latter may include reducing carbohydrate intake and increasing intake of healthy fats in combination with an anti-inflammatory diet (a dietary approach that emphasizes the consumption of foods with anti-inflammatory properties while minimizing or avoiding foods that can promote inflammation) to reduce systemic inflammation [73]. Furthermore, enhanced physical activity and exercise, especially exercises which build skeletal muscle (i.e., weight lifting, burst training, or high-intensity interval training), as well as effective management of psychological stress, can improve insulin sensitivity [62,71,72]. Given that antipsychotic agents are essential in treating schizophrenia, and that the risk of prediabetes and T2D rapidly increases following the initiation of antipsychotic treatment, nonpharmacological measures may be clinically beneficial.…”