Sex-specific differences in diabetes prevention: a systematic review and meta-analysis

Glechner, Anna; Harreiter, Jürgen; Gartlehner, Gerald; Rohleder, Sonja; Kautzky, Alexander; Tuomilehto, Jaakko; Noord, Megan Van; Kaminski‐Hartenthaler, Angela; Kautzky‐Willer, Alexandra

doi:10.1007/s00125-014-3439-x

Cited by 46 publications

(50 citation statements)

References 66 publications

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“…25 27 29 37 One considered four primary studies and noted no gender differences in either 1-year or 2-year follow-up meta-analysis results 29. In contrast, analysis of data from 19 studies in a second review suggested that each 1-unit increase in study-level baseline percentage of men was associated with a 3% higher diabetes incidence 25.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Resultsmentioning

confidence: 99%

“…29 Review of pooled individual-level data from three primary studies suggested no impact of gender on weight outcomes,29 but again a study-level review suggested that each percentage increase in the proportion of male participants was borderline significantly associated with 0.05 kg net weight gain 25…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2016

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“…We undertook the present analysis based on the observation from clinical lifestyle intervention trials that the improvement of glycaemia, which was achieved during the intervention, was relatively heterogeneous [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Furthermore, several problems about successful translation of such interventions to clinical practice have been identified [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

“…Conclusions/interpretation Stratification of individuals with prediabetes at baseline into a high-risk and a low-risk phenotype, based on corrected insulin secretion and insulin-resistant NAFLD, may help to determine the effectiveness of a lifestyle intervention to revert individuals to NGR. [1][2][3][4][5][6][7][8][9][10]. However, although this safe intervention is generally very effective at preventing diabetes, some people still develop the disease [1,3].…”

Section: Introductionmentioning

confidence: 99%

A high-risk phenotype associates with reduced improvement in glycaemia during a lifestyle intervention in prediabetes

et al. 2015

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Aims/hypothesis Lack of reversal of prediabetes (impaired glucose tolerance and/or impaired fasting glucose) to normal glucose regulation (NGR) during a lifestyle intervention is strongly associated with a higher incidence of diabetes later in life. In the Tübingen Lifestyle Intervention Program (TULIP) we hypothesised that an at-risk phenotype may exist at baseline that associates with this nonresponse to the intervention. Methods A total of 120 participants of TULIP with prediabetes at baseline were studied. Participants underwent 9 months of lifestyle intervention and had measurements of insulin secretion and insulin sensitivity during a 75 g OGTT, and measurements of liver fat content by proton magnetic resonance spectroscopy. Results During the lifestyle intervention, 55% of the participants did not revert to NGR. Even among participants with the largest body fat loss (upper quartile: −6.9±3.3%, mean±SD), 40% did not revert to NGR. In this regard, we identified at baseline a high-risk phenotype (n=72) consisting of low disposition index or low insulin sensitivity+nonalcoholic fatty liver disease (NAFLD) and a low-risk phenotype (n=48, all other traits). While the adjusted decrease in body fat was almost identical between these phenotypes (−5.7±15.3% vs −7.7±15.2%, p=0.49), the high-risk phenotype had a smaller decrease in adjusted 2 h blood glucose levels (−3.7±20.3% vs −18.5±20.0%, p=0.0009). In addition, only 31% of the participants with the high-risk phenotype, but 67% with the lowrisk phenotype, reverted to NGR (p<0.0001). The odds ratio for reaching the status NGR was 4.54 (95% CI 2.08, 9.94) for participants having the low-risk phenotype. Conclusions/interpretation Stratification of individuals with prediabetes at baseline into a high-risk and a low-risk phenotype, based on corrected insulin secretion and insulin-resistant NAFLD, may help to determine the effectiveness of a lifestyle intervention to revert individuals to NGR.

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“…The US Diabetes Prevention Programme (DPP) found greater weight loss in men than women but the difference was not stated (1). A systematic review and meta-analysis on sex-specific differences in diabetes prevention found no evidence of sex differences in weight loss in people with prediabetes although weight loss at 3-years follow-up was greater in men than women (confidence intervals overlapped) (2). In a further systematic review of weight loss interventions, weight loss was found to be greater in men than in women in 80% of studies where a direct comparison was possible.…”

Section: Introductionmentioning

confidence: 99%

Did the weight loss in the Prevention of Diabetes and Obesity in South Asians (PODOSA) trial differ by sex? An exploratory analysis

et al. 2017

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Sex-specific differences in diabetes prevention: a systematic review and meta-analysis

Cited by 46 publications

References 66 publications

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

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

A high-risk phenotype associates with reduced improvement in glycaemia during a lifestyle intervention in prediabetes

Did the weight loss in the Prevention of Diabetes and Obesity in South Asians (PODOSA) trial differ by sex? An exploratory analysis

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