Introduction
Several interventions have been found to be effective for reversing prediabetes in
adults. This systematic review and meta-analysis aims to compare the effectiveness
of such interventions.
Methods
MEDLINE, Embase, and Cochrane Library databases were searched for articles published
between January 1, 2000 and June 27, 2018. RCTs in adults with prediabetes, testing
nonsurgical interventions lasting for ≥3 months, and reporting the number of participants
achieving normal glucose levels at intervention end were eligible. The pooled risk
difference and number needed to treat for achieving normoglycemia were estimated using
a random-effects, arm-based network meta-analysis. The strength of the evidence was
assessed using Grading of Recommendations Assessment, Development, and Evaluation.
Data were obtained in 2018 and analyzed in 2019 and 2021.
Results
Of 54 studies included in the systematic review, 47 were meta-analyzed (n=26,460, mean age=53 years, 46% male, 31% White). Studies included 27 arms testing
lifestyle modification interventions, 25 testing medications, 5 testing dietary supplements,
and 10 testing Chinese medicine. There were 35 control/placebo arms. At a median follow-up
of 1.6 years, more participants in the lifestyle modification groups achieved normoglycemia
than those in the control (risk difference=0.18, number needed to treat=6). The strength
of the evidence was strong for lifestyle modification. Over a median follow-up of
2.7 years, more participants receiving glucagon-like peptide-1 receptor agonists (risk
difference=0.47, number needed to treat=2), α-glucosidase inhibitors (risk difference=0.29,
number needed to treat=4), and insulin sensitizers (risk difference=0.23, number needed
to treat=4) achieved normoglycemia than control. The strength of evidence was moderate
for these medications.
Discussion
Although several pharmacological approaches can reverse prediabetes, lifestyle modification
provides the strongest evidence of effectiveness and should remain the recommended
approach to address this condition.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global epidemiology of prediabetes - present and future perspectives.Clin Diabetes Endocrinol. 2019; 5: 5https://doi.org/10.1186/s40842-019-0080-0
IDF diabetes atlas, 9th edition. International Diabetes Federation. https://www.diabetesatlas.org/en/. Updated 2019. Accessed March 19, 2020.
- Prevalence of pre-diabetes across ethnicities: a review of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) for classification of dysglycaemia.Nutrients. 2017; 9: 1273https://doi.org/10.3390/nu9111273
- Annual incidence and relative risk of diabetes in people with various categories of dysglycemia: a systematic overview and meta-analysis of prospective studies.Diabetes Res Clin Pract. 2007; 78: 305-312https://doi.org/10.1016/j.diabres.2007.05.004
- Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? A meta-analysis of prospective studies.Arch Intern Med. 2004; 164: 2147-2155https://doi.org/10.1001/archinte.164.19.2147
- Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988-2014.Lancet Diabetes Endocrinol. 2018; 6: 392-403https://doi.org/10.1016/S2213-8587(18)30027-5
- Association between prediabetes and risk of chronic kidney disease: a systematic review and meta-analysis.Diabet Med. 2016; 33: 1615-1624https://doi.org/10.1111/dme.13113
- Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis.BMJ. 2020; 370: m2297https://doi.org/10.1136/bmj.m2297
- Association between varying cut-points of intermediate hyperglycemia and risk of mortality, cardiovascular events and chronic kidney disease: a systematic review and meta-analysis.BMJ Open Diabetes Res Care. 2021; 9e001776https://doi.org/10.1136/bmjdrc-2020-001776
- The alarming and rising costs of diabetes and prediabetes: a call for action!.Diabetes Care. 2014; 37: 3137-3138https://doi.org/10.2337/dc14-2329
- Prevention of type 2 diabetes with the traditional Chinese patent medicine: a systematic review and meta-analysis.Diabetes Res Clin Pract. 2017; 131: 242-259https://doi.org/10.1016/j.diabres.2017.07.020
- Prevention of type 2 diabetes with the Chinese herbal medicine Tianqi capsule: a systematic review and meta-analysis [published correction appears in Diabetes Ther. 2017;8(6):1243-1244].Diabetes Ther. 2017; 8: 1227-1242https://doi.org/10.1007/s13300-017-0316-x
- Oral antidiabetic drugs and regression from prediabetes to normoglycemia: a meta-analysis.Ann Pharmacother. 2012; 46: 469-476https://doi.org/10.1345/aph.1Q554
- Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force.Ann Intern Med. 2015; 163: 437-451https://doi.org/10.7326/M15-0452
- Effects of vitamin D supplementation on prevention of type 2 diabetes in patients with prediabetes: a systematic review and meta-analysis.Diabetes Care. 2020; 43: 1650-1658https://doi.org/10.2337/dc19-1708
- Subjects with impaired glucose tolerance returned to normal glucose status for six years had lower long-term risk of diabetes: 20 years follow up of Daqing diabetes prevention study.Zhonghua Nei Ke Za Zhi. 2019; 58: 372-376https://doi.org/10.3760/cma.j.issn.0578-1426.2019.05.008
- Reversion from pre-diabetes mellitus to normoglycemia and risk of cardiovascular disease and all-cause mortality in a Chinese population: a prospective cohort study.J Am Heart Assoc. 2021; 10e019045https://doi.org/10.1161/JAHA.120.019045
- Regression from prediabetes to normal glucose regulation is associated with reduction in cardiovascular risk: results from the Diabetes Prevention Program Outcomes Study.Diabetes Care. 2014; 37: 2622-2631https://doi.org/10.2337/dc14-0656
- Regression from prediabetes to normal glucose regulation and prevalence of microvascular disease in the Diabetes Prevention Program Outcomes Study (DPPOS).Diabetes Care. 2019; 42: 1809-1815https://doi.org/10.2337/dc19-0244
- Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study.Lancet. 2012; 379: 2243-2251https://doi.org/10.1016/S0140-6736(12)60525-X
- The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.Ann Intern Med. 2015; 162: 777-784https://doi.org/10.7326/M14-2385
- 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020.Diabetes Care. 2020; 43: S14-S31https://doi.org/10.2337/dc20-S002
- Classification of diabetes mellitus.WHO, Geneva, Switzerland2019 (Published April 21, 2019. Accessed September 8, 2020)
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928https://doi.org/10.1136/bmj.d5928
- ‘Arm-based’ parameterization for network meta-analysis.Res Synth Methods. 2016; 7: 306-313https://doi.org/10.1002/jrsm.1187
- Network meta-analysis of randomized clinical trials: reporting the proper summaries.Clin Trials. 2014; 11: 246-262https://doi.org/10.1177/1740774513498322
- Thompson SG. Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558https://doi.org/10.1002/sim.1186
- Network meta-analysis using R: a review of currently available automated packages [published correction appears in PLoS One. 2015;10(4):e0123364].PLoS One. 2014; 9e115065https://doi.org/10.1371/journal.pone.0115065
- GRADE approach to rate the certainty from a network meta-analysis: avoiding spurious judgments of imprecision in sparse networks.J Clin Epidemiol. 2019; 105: 60-67https://doi.org/10.1016/j.jclinepi.2018.08.022
- Standards of medical care in diabetes.Diabetes Care. 2021; 44: S1-S2https://care.diabetesjournals.org/content/44/Supplement_1Date accessed: August 11, 2021
- Evidence and potential mechanisms of traditional Chinese medicine for the treatment of type 2 diabetes: a systematic review and meta-analysis.Diabetes Obes Metab. 2019; 21: 1801-1816https://doi.org/10.1111/dom.13760
- Dietary supplements for prediabetes: a protocol for a systematic review and meta-analysis.Medicine (Baltimore). 2020; 99: e20347https://doi.org/10.1097/MD.0000000000020347
- Efficacy of lifestyle interventions in the reversion to normoglycemia in Korean prediabetics: one-year results from a randomised controlled trial.Prim Care Diabetes. 2019; 13: 212-220https://doi.org/10.1016/j.pcd.2018.11.017
- Prediabetes conversion to normoglycemia is superior adding a low-carbohydrate and energy deficit formula diet to lifestyle intervention-a 12-month subanalysis of the ACOORH Trial.Nutrients. 2020; 12: 2022https://doi.org/10.3390/nu12072022
- Effects of a 12-month intensive lifestyle monitoring program in predominantly overweight/obese Arab adults with prediabetes.Nutrients. 2020; 12: 464https://doi.org/10.3390/nu12020464
- Early lifestyle interventions in people with impaired glucose tolerance in Northern Colombia: the DEMOJUAN Project.Int J Environ Res Public Health. 2019; 16: 1403https://doi.org/10.3390/ijerph16081403
- Effect of lorcaserin on prevention and remission of type 2 diabetes in overweight and obese patients (CAMELLIA-TIMI 61): a randomised, placebo-controlled trial.Lancet. 2018; 392: 2269-2279https://doi.org/10.1016/S0140-6736(18)32328-6
- Acute and long-term effects of saxagliptin on post-prandial glycemic response in obese patients with impaired glucose tolerance.Nutr Metab Cardiovasc Dis. 2021; 31: 1257-1266https://doi.org/10.1016/j.numecd.2020.12.025
- Vitamin D Supplementation in Overweight/Obese Asian Indian Women With Prediabetes Reduces Glycemic Measures and Truncal Subcutaneous Fat: a 78 Weeks Randomized Placebo-Controlled Trial (PREVENT-WIN Trial).Sci Rep. 2020; 10: 9844https://doi.org/10.1038/s41598-020-67064-9
- Effect of Gymnema sylvestre administration on glycemic control, insulin secretion, and insulin sensitivity in patients with impaired glucose tolerance.J Med Food. 2021; 24: 28-32https://doi.org/10.1089/jmf.2020.0024
- Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia.Cochrane Database Syst Rev. 2018; 10 (CD012661)https://doi.org/10.1002/14651858.CD012661
- The epidemic of pre-diabetes: the medicine and the politics [published correction appears in BMJ. 2014;349:g4683].BMJ. 2014; 349: g4485https://doi.org/10.1136/bmj.g4485
- What's in a name? Redefining type 2 diabetes remission.Diabetes Ther. 2021; 12: 647-654https://doi.org/10.1007/s13300-020-00990-z
Article Info
Publication History
Published online: February 10, 2022
Identification
Copyright
© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
