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Efficacy of Lifestyle Education to Prevent Type 2 Diabetes

A meta-analysis of randomized controlled trials

Department of Technology Assessment and Biostatistics, National Institute of Public Health, Wako, Saitama, Japan

Address correspondence and reprint requests to Kazue Yamaoka, PhD, Department of Technology Assessment and Biostatistics, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 351-0197, Japan. E-mail: yamaoka{at}niph.go.jp

ABSTRACT

OBJECTIVE—To evaluate the efficacy of lifestyle education for preventing type 2 diabetes in individuals at high risk by meta-analysis of randomized controlled trials, as assessed by incidence and a reduced level of plasma glucose 2 h after a 75-g oral glucose load (2-h plasma glucose).

RESEARCH DESIGN AND METHODS—Through an electronic search, 123 studies were identified. A literature search identified eight studies that met strict inclusion criterion of meta-analysis for 2-h plasma glucose and five studies for the incidence of diabetes. All were randomized controlled trials of 6 months with lifestyle education that included a dietary intervention. Subjects were adults diagnosed as being at high risk for type 2 diabetes. The difference in mean reduction of 2-h plasma glucose from baseline to the 1-year follow-up and relative risk (RR) of the incidence of diabetes in the lifestyle education group versus the control group were assessed. Overall estimates were calculated using a random-effects model. Those estimates were confirmed by several models, and the possibility of selection bias was examined using a funnel plot.

RESULTS—Lifestyle education intervention reduced 2-h plasma glucose by 0.84 mmol/l (95% CI 0.39–1.29) compared with the control group. The 1-year incidence of diabetes was reduced by 50% (RR 0.55, 95% CI 0.44–0.69) compared with the control group. Results were stable and little changed if data were analyzed by subgroups or other statistical models. Funnel plots revealed no selection bias.

CONCLUSIONS—Lifestyle education was effective for reducing both 2-h plasma glucose and RR in high-risk individuals and may be a useful tool in preventing diabetes.

Abbreviations: DPPRG, Diabetes Prevention Program Research Group • IFG, impaired fasting glucose • IGT, impaired glucose tolerance

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