Background: Type 2 diabetes mellitus (T2DM) is a prevalent disease and remains a substantial economic burden on society. Intensive lifestyle modification (ILM) and metformin are common interventions aimed at individuals with prediabetes to prevent the progression to T2DM.

Objective: To assess the effect of ILM and metformin interventions by evaluating fasting blood glucose (FBG).

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Databases including MEDLINE, CINHAL, Nutrition and Food Sciences, and ProQuest were searched. Inclusion criteria were individuals with prediabetes, had separate ILM and metformin interventions, and assessed baseline and post-intervention FBG. Exclusion criteria were individuals outside the age of 13-65 years, had unrelated medical conditions, taking other diabetic medications, and <12 weeks in duration. Statistical analysis was completed using the Comprehensive Meta-Analysis software (CMA).

Results: Of 257 studies, 5 RCTs with a total of 4,045 participants were included for analysis. ILM was significantly associated with a lower FBG level post-intervention compared to metformin (MD±SEM=-0.15±0.068; p=0.026) and placebo (MD±SEM= -0.37±0.12; p=0.003). Metformin was significantly associated with a lower FBG post-intervention compared to placebo (MD±SEM= -0.25±0.059; p=0.00).

Conclusion: ILM and metformin interventions are associated with an improvement in FBG compared to placebo. Although our analysis showed a statistical benefit of ILM compared to metformin, we conclude that the clinical significance in FBG is comparable for supporting both interventions. In addition, appropriate cost-effective interventions should be considered to reduce the economic burden on society. Prioritizing multidisciplinary teams is important for successful implementation and preventing T2DM in this population.


M. Kucab: None. T. Boateng: None. I. Young: None. E. Gucciardi: None.

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