Global Approaches to Diabetes Prevention: A Systematic Review and Meta-Analysis of Randomized Controlled Studies Público
Ramanna, Veena (Spring 2020)
Abstract
Background: Clinical trials conducted in controlled research settings have shown strong evidence that lifestyle modifications, pharmacotherapeutic approaches and dietary supplement interventions can reduce the risk of diabetes incidence in the prediabetes population. This systematic review summarizes evidence gathered from randomized controlled trials where the impact of diverse approaches to prevent diabetes is evaluated in global settings.
Methods: A systematic search on Medline was performed to identify peer reviewed articles published between January 1, 1990 and October 22, 2019. These randomized controlled trials included individuals with prediabetes >19 years old, testing diabetes prevention interventions of at least 6 months duration, that reported diabetes incidence. Risk of bias for each study was assessed using the Cochrane collaboration. A random effects meta-analysis was employed to obtain a pooled relative risk for diabetes development by intervention type. Meta-regressions were employed to explore sources of heterogeneity for treatment effects.
Results: We included 65 studies (n=56,562 & 90,439, mean age=54.7 years, males =53% & 55.6% in the intervention and control groups respectively. White/European participants were reported in 33 studies). Of these, 31 tested lifestyle modification approaches, 25 pharmacotherapeutic approaches, and 9 dietary supplements. Studies were deemed to have low risk of bias. Lifestyle modification associated with a 31% relative risk reduction (RR = 0.69 [95% CI 0.61, 0.79]) and medications associated with a 37% relative risk reduction (RR = 0.63 [95% CI 0.54, 0.75]). Supplements did not significantly reduced diabetes risk (RR = 0.74 [95% CI 0.61, 0.74]). A meta-regression including participant weight loss explained 68.3% and 17% of heterogeneity in effects in the lifestyle and pharmacotherapeutic interventions, respectively (R2=68.27%, p=0.0014 and R2=16.78%, p=0.0877).
Conclusion: Globally, lifestyle modification and pharmacotherapeutic approaches effectively decrease the incidence of type 2 diabetes in adults at risk. National level diabetes programs should continue to be rolled out to halt diabetes incidence.
Table of Contents
Table of Contents
Introduction. 1
The Burden of Type 2 Diabetes. 1
Risk Factors. 2
Efficacy of Diabetes Prevention Approaches. 4
Purpose of the Current Study. 7
Methods. 9
Overview.. 9
Study Search and Selection. 9
Screening and Data Extraction. 10
Risk of Bias Assessment 10
Data Analysis. 13
Results. 15
Study characteristics. 15
Risk of bias. 16
Diabetes incidence. 18
Assessment of publication bias. 21
Discussion. 25
Summary. 25
Strengths. 27
Limitations. 28
Conclusion. 29
References. 30
Appendix 1. PICO Framework for search strategy. 35
Appendix 2. Study screening and selection flow-diagram.. 36
Appendix 3. Supplement Table 1 – Baseline Characteristics. 37
Appendix 4. Quality - Risk of Bias chart………………………………………………………………………………………………….43
Appendix 5. Bibliography of studies included in meta analysis………………………………………………………………45
About this Master's Thesis
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