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Cited by 147Diabetes, Cardiovascular Risks, and LipoproteinsPhysical Activity and HealthDiabetes Management and Education

Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis

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Cardona-Morrell, Magnolia, Rychetnik, Lucie, Morrell, Stephen L, Espinel, Paola T, Bauman, Adrian·2010·BMC Public Health
DOI 10.1186/1471-2458-10-653PMC PMC2989959
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Abstract

BACKGROUND: The clinical effectiveness of intensive lifestyle interventions in preventing or delaying diabetes in people at high risk has been established from randomised trials of structured, intensive interventions conducted in several countries over the past two decades. The challenge is to translate them into routine clinical settings. The objective of this review is to determine whether lifestyle interventions delivered to high-risk adult patients in routine clinical care settings are feasible and effective in achieving reductions in risk factors for diabetes. DATA SOURCES: MEDLINE (PubMed), EMBASE, CINAHL, The Cochrane Library, Google Scholar, and grey literature were searched for English-language articles published from January 1990 to August 2009. The reference lists of all articles collected were checked to ensure that no relevant suitable studies were missed. STUDY SELECTION: We included RCTs, before/after evaluations, cohort studies with or without a control group and interrupted time series analyses of lifestyle interventions with the stated aim of diabetes risk reduction or diabetes prevention, conducted in routine clinical settings and delivered by healthcare providers such as family physicians, practice nurses, allied health personnel, or other healthcare staff associated with a health service. Outcomes of interest were weight loss, reduction in waist circumference, improvement of impaired fasting glucose or oral glucose tolerance test (OGTT) results, improvements in fat and fibre intakes, increased level of engagement in physical activity and reduction in diabetes incidence. RESULTS: Twelve from 41 potentially relevant studies were included in the review. Four studies were suitable for meta-analysis. A significant positive effect of the interventions on weight was reported by all study types. The meta-analysis showed that lifestyle interventions achieved weight and waist circumference reductions after one year. However, no clear effects on biochemical or clinical parameters were observed, possibly due to short follow-up periods or lack of power of the studies meta-analysed. Changes in dietary parameters or physical activity were generally not reported. Most studies assessing feasibility were supportive of implementation of lifestyle interventions in routine clinical care. CONCLUSION: Lifestyle interventions for patients at high risk of diabetes, delivered by a variety of healthcare providers in routine clinical settings, are feasible but appear to be of limited clinical benefit one year after intervention. Despite convincing evidence from structured intensive trials, this systematic review showed that translation into routine practice has less effect on diabetes risk reduction.

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Crossref · 10.1186/1471-2458-10-653

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  • The authors' weight-loss findings are consistent with other meta-analyses showing a pre/post weight loss of 2.3-3.8 kg and a between-group weight loss difference of 1.6-2.7 kg.

    “Regarding weight loss, our findings are consistent with those from other meta-analyses showing a pre/post weight loss of 2.3–3.8 kg (9,10) and a between-group weight loss difference of 1.6–2.7 kg (7,9,10,14).”

    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 [7]

    The Results > Meta-analysis results section reports a between-group weight-loss difference of 1.82 kg at 12 months, within the cited 1.6–2.7 kg range. The paper does not report a pooled pre/post weight loss of 2.3–3.8 kg; its Results > Consistency of findings with reference trials section gives 1.82 kg for the four RCTs. (LLM, conf=0.86)

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  • Null effects for PPG may be due to lack of power given that PPG is an expensive glucose measure requiring a larger time commitment for participants and staff and thus is seldom used in translation studies.

    “As in a previous meta-analysis (7), null effects were observed for PPG, which may be due to lack of power given that PPG is an expensive glucose measure requiring a larger time commitment for participants and staff and thus is seldom used in translation studies.”

    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 [7]

    The Results > Meta-analysis results (page unavailable) report a nonsignificant effect for the 2-hour oral glucose tolerance test, and Results > Type of outcomes reported says only 3 of 12 studies measured it. The paper does not say the measure's expense or time demands explain its infrequent use or the nonsignificant result. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Effects of real-world lifestyle modification strategies on glucose outcomes are mixed, with both positive and null estimates obtained.

    “Effects on glucose outcomes are mixed, with both positive and null estimates having been obtained (7,10,11).”

    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 [7]

  • Existing meta-analyses show that lifestyle modification strategies to prevent type 2 diabetes delivered under real-world conditions are effective for promoting weight loss.

    “Existing meta-analyses show that LSM strategies to prevent type 2 diabetes that are delivered under real-world conditions are effective for promoting weight loss (7–11)”

    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 [7]

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Research works printed but not linked: 1

  1. Lindström J Ilanne-Parikka P Peltonen M Aunola S Eriksson JG Hemiö K Hämäläinen H Härkönen P Keinänen-Kiukaanniemi S Laakso M Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study The Lancet 2006 368 9548 1673 1679 10.1016/S0140-6736(06)69701-8 17098085 · DOI · Paper page

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Authors
Cardona-Morrell, M., Rychetnik, L., Morrell, S. L., Espinel, P. T., & Bauman, A.
Affiliations
The University of Sydney (AU)
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2010-10-29
Volume
10
Issue
1
Pages
653-653
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/1471-2458-10-653
PMC
PMC2989959
OpenAlex
W2036822195
Cited by
147
References
95
Citations by year
2026: 2 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 7 · 2021: 6 · 2020: 6 · 2019: 7 · 2018: 10 · 2017: 11 · 2016: 13 · 2015: 25 · 2014: 22 · 2013: 10 · 2012: 12
FWCI
1.18
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
diabetes prevention, lifestyle intervention, physical activity, nutrition interventions, high-risk adults, routine clinical practice, weight loss, waist circumference, impaired fasting glucose, oral glucose tolerance test, dietary fiber intake, dietary fat intake, implementation feasibility, clinical translation
MeSH terms
Adult, Aged, Aged, 80 and over, Diabetes Mellitus, Feeding Behavior, Female, Humans, Life Style, Male, Middle Aged, Reproducibility of Results, Exercise, Randomized Controlled Trials as Topic, Risk Reduction Behavior

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