Do lifestyle interventions modeled after the Diabetes Prevention Program change weight, blood glucose and A1c? A meta-analysis Open Access

Mudaliar, Uma (2013)

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This manuscript is a systematic review and meta-analysis of studies in the US which implemented principles tested in the Diabetes Prevention Program's Lifestyle Intervention, which has shown to effectively help participants with prediabetes decrease their risk of progressing to diabetes by 58%. We included all US based studies published between January 2003 and April 2011 which evaluated a DPP based intervention in people 18 years and older at high risk of diabetes which reported pre- and post- intervention values in weight, fasting blood glucose, or hemoglobin A1c.

A total of thirty-two studies met eligibility for inclusion in this meta-analysis by reporting one or more outcomes of interest. All studies reported weight change, seventeen had pre- and post-intervention data on FBG (capillary or venous), and six had follow up measures on HbA1c. In total, there were 5,094 participants enrolled across all studies. On average, participants' mean age was 54.5 years, 73.1% were female, and BMI was 34.0 kg/m2.

Mean absolute weight change was -4.18 kg (95% CI: -5.12; -3.24), mean change in A1c was -0.19%% (95% CI: -0.28; -0.11) and mean change in fasting blood glucose was -2.68 mg/dl (95% CI:-4.15; -1.11). Despite the modifications made to the original DPP intervention, the translation into real world settings still accomplished similar decreases in weight, FBG and HbA1c as the original DPP study.

Diabetes is fortunate to have an early, reliable predictor of future disease risk. The opportunity to intervene early in approximately 79 million in the US with prediabetes with timely referral to lifestyle intervention programs is currently missed. Although patients are often advised to lose weight and make dietary changes, the ability of standard advice alone is not effective. Many of these programs show great promise in decreasing the cost, incidence, morbidity and mortality of diabetes.

Table of Contents

Table of Contents

Introduction. page 1

Methods. page 2

Study Selection. page 2

Quality Assessment page 3

Data Analysis. page4

Results. page5

Findings Stratified by Outcome. page 6

Figure 1: Mean weight change of study participants. page 7

Figure 2: Mean change in fasting blood glucose in study participants. page 8

Figure 3: Mean change in A1c in study participants. page 9

Discussion. page 9

Limitations. page 12

Conclusion. page 13

Implications and future directions. page13

Appendix. page 15

Exhibit A: Search strategy. page15

Exhibit B: List of search terms that were included in each database. page 16

Exhibit C: Complete List of Articles. page 18

References: page 20

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