Lifestyle Interventions for Patients With and at Risk for Type 2 Diabetes: A Systematic Review and Meta-analysis
Abstract
BACKGROUND: The effect of multifaceted lifestyle interventions on clinically oriented outcomes across a spectrum of metabolic risk factors and abnormal glucose is unclear. PURPOSE: To systematically review the effectiveness of lifestyle interventions on minimizing progression to diabetes in high-risk patients or progression to clinical outcomes (such as cardiovascular disease and death) in patients with type 2 diabetes. DATA SOURCES: 5 electronic databases (1980 to June 2013), reference lists, and gray literature. STUDY SELECTION: Two reviewers independently identified randomized, controlled trials of lifestyle interventions (≥3 months' duration) that included exercise, diet, and at least 1 other component; the comparator was standard care. DATA EXTRACTION: One reviewer extracted and a second verified data. Two reviewers independently assessed methodological quality. DATA SYNTHESIS: Nine randomized, controlled trials with patients who were at risk for diabetes and 11 with patients who had diabetes were included. Seven studies reported that lifestyle interventions decreased the risk for diabetes from the end of intervention up to 10 years after it. In patients with diabetes, 2 randomized, controlled trials (which included pharmacotherapy) reported no improvement in all-cause mortality (risk ratio, 0.75 [95% CI, 0.53 to 1.06]). Composite outcomes for cardiovascular disease were too heterogeneous to pool. One trial reported improvement in microvascular outcomes at 13-year follow-up. LIMITATION: Most trials focused on surrogate measures (such as weight change, blood pressure, and lipids) for which clinical relevance was unclear. CONCLUSION: Comprehensive lifestyle interventions effectively decrease the incidence of type 2 diabetes in high-risk patients. In patients who already have type 2 diabetes, there is no evidence of reduced all-cause mortality and insufficient evidence to suggest benefit on cardiovascular and microvascular outcomes. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
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Evidence is limited regarding the impact of an overall healthy lifestyle after diabetes diagnosis on the risk of subsequent cardiovascular events.
“but the evidence regarding the impact of an overall healthy lifestyle after diabetes diagnosis on the risk of subsequent cardiovascular events is limited (6).”
From Influence of lifestyle on incident cardiovascular disease and mortality in patients with diabetes mellitus (2018) · cites this paper as [6]
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- Authors
- Schellenberg, E. S., Dryden, D. M., Vandermeer, B., Ha, C., & Korownyk, C.
- Affiliations
- From the University of Alberta Evidence-based Practice Center and Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada.
- University of Alberta (CA)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2013-10-15
- Volume
- 159
- Issue
- 8
- Pages
- 543-551
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2002039072
- Cited by
- 520
- References
- 68
- Citations by year
- 2026: 14 · 2025: 37 · 2024: 42 · 2023: 40 · 2022: 56 · 2021: 46 · 2020: 42 · 2019: 38 · 2018: 36 · 2017: 34 · 2016: 42 · 2015: 43 · 2014: 48 · 2013: 2
- FWCI
- 6.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Annals of Internal Medicine
- Funders
- U.S. Public Health Service (290-2007-10021-I)
- 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 Education
- Keywords
- type 2 diabetes, lifestyle intervention, diabetes prevention, high-risk patients, physical activity, diet, all-cause mortality, cardiovascular disease, microvascular outcomes, metabolic risk factors
- MeSH terms
- Diabetes Mellitus, Type 2, Diet, Humans, Life Style, Risk Factors, Exercise, Incidence, Diabetes Complications
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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