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Cited by 354Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementDiabetes Management and Research

Long-term Sustainability of Diabetes Prevention Approaches: A Systematic Review and Meta-analysis of Randomized Clinical Trials

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Haw, J. Sonya, Galaviz, Karla I., Straus, Audrey N., Kowalski, Alysse J., Magee, Matthew J., Weber, Mary Beth, Wei, Jingkai, Narayan, K. M. Venkat +1 more·2017·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2017.6040PMC PMC5820728
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Abstract

Importance: Diabetes prevention is imperative to slow worldwide growth of diabetes-related morbidity and mortality. Yet the long-term efficacy of prevention strategies remains unknown. Objective: To estimate aggregate long-term effects of different diabetes prevention strategies on diabetes incidence. Data Sources: Systematic searches of MEDLINE, EMBASE, Cochrane Library, and Web of Science databases. The initial search was conducted on January 14, 2014, and was updated on February 20, 2015. Search terms included prediabetes, primary prevention, and risk reduction. Study Selection: Eligible randomized clinical trials evaluated lifestyle modification (LSM) and medication interventions (>6 months) for diabetes prevention in adults (age ≥18 years) at risk for diabetes, reporting between-group differences in diabetes incidence, published between January 1, 1990, and January 1, 2015. Studies testing alternative therapies and bariatric surgery, as well as those involving participants with gestational diabetes, type 1 or 2 diabetes, and metabolic syndrome, were excluded. Data Extraction and Synthesis: Reviewers extracted the number of diabetes cases at the end of active intervention in treatment and control groups. Random-effects meta-analyses were used to obtain pooled relative risks (RRs), and reported incidence rates were used to compute pooled risk differences (RDs). Main Outcomes and Measures: The main outcome was aggregate RRs of diabetes in treatment vs control participants. Treatment subtypes (ie, LSM components, medication classes) were stratified. To estimate sustainability, post-washout and follow-up RRs for medications and LSM interventions, respectively, were examined. Results: Forty-three studies were included and pooled in meta-analysis (49 029 participants; mean [SD] age, 57.3 [8.7] years; 48.0% [n = 23 549] men): 19 tested medications; 19 evaluated LSM, and 5 tested combined medications and LSM. At the end of the active intervention (range, 0.5-6.3 years), LSM was associated with an RR reduction of 39% (RR, 0.61; 95% CI, 0.54-0.68), and medications were associated with an RR reduction of 36% (RR, 0.64; 95% CI, 0.54-0.76). The observed RD for LSM and medication studies was 4.0 (95% CI, 1.8-6.3) cases per 100 person-years or a number-needed-to-treat of 25. At the end of the washout or follow-up periods, LSM studies (mean follow-up, 7.2 years; range, 5.7-9.4 years) achieved an RR reduction of 28% (RR, 0.72; 95% CI, 0.60-0.86); medication studies (mean follow-up, 17 weeks; range, 2-52 weeks) showed no sustained RR reduction (RR, 0.95; 95% CI, 0.79-1.14). Conclusions and Relevance: In adults at risk for diabetes, LSM and medications (weight loss and insulin-sensitizing agents) successfully reduced diabetes incidence. Medication effects were short lived. The LSM interventions were sustained for several years; however, their effects declined with time, suggesting that interventions to preserve effects are needed.

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  • In countries with universal health insurance and good access to primary care, people at high risk of diabetes might be identified early and advised to use a combination of diet and lifestyle modifications and medicines to prevent or delay diabetes onset.

    “In countries with universal health insurance and good access to primary care, people at a high risk of diabetes might also be identified early and advised to use a combination of diet and lifestyle modifications and medicines to prevent or delay diabetes onset.48–55”

    From Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants (2024) · cites this paper as [53]

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  • Diet and lifestyle modification and medicines in people at high risk of diabetes (including those with prediabetes) can prevent or delay diabetes onset and reduce the risk of some complications.

    “Alongside these population-based measures, diet and lifestyle modification and medicines in people at a high risk of diabetes (including those with prediabetes) can prevent or delay diabetes onset and reduce the risk of some complications.48–55”

    From Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants (2024) · cites this paper as [53]

    The Discussion (page not provided) reports that lifestyle modification and certain medications prevent progression to diabetes in people at risk. The paper evaluates diabetes incidence, but the passages do not show that these interventions reduce the risk of complications; that part of the attributed claim is unsupported. (LLM, conf=0.86)

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  • In the authors' previous meta-analysis, the effects of LSM strategies were shown to wane with time.

    “Indeed, in our previous meta-analysis, we showed the effects of LSM strategies wane with time (38), suggesting strategies to maintain intervention effects in the long term are needed.”

    From Global diabetes prevention interventions: A systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose (2018) · cites this paper as [38]

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Authors
Haw, J. S., Galaviz, K. I., Straus, A. N., Kowalski, A. J., Magee, M. J., Weber, M. B., Wei, J., Narayan, K. M. V., & Ali, M. K.
Affiliations
  • Emory University (US)
  • CommUnityCare Health Centers, Austin, Texas
  • Georgia State University (US)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Haw, J. Sonya
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2017-12-01
Volume
177
Issue
12
Pages
1808
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2017.6040
PMC
PMC5820728
OpenAlex
W2767584659
Cited by
354
References
17
Citations by year
2026: 33 · 2025: 39 · 2024: 48 · 2023: 44 · 2022: 38 · 2021: 35 · 2020: 39 · 2019: 44 · 2018: 33 · 2016: 1
FWCI
4.62
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007734)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
diabetes prevention, prediabetes, lifestyle modification, antidiabetic drugs, long-term efficacy, washout period, diabetes incidence, primary prevention, risk mitigation, type 2 diabetes
MeSH terms
Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Insulin Resistance, Life Style, Primary Prevention, Risk, Weight Loss, Randomized Controlled Trials as Topic

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