Objective: In this meta-analysis, we compared the effect of different non-surgical diabetes prevention strategies on regression to normoglycemia among people with prediabetes.
Methods: We systematically searched MEDLINE, EMBASE and Cochrane Library for articles published between 01-01-2000 to 05-30-2017. We included randomized controlled trials testing non-surgical interventions to prevent diabetes or improve glucose tolerance in adults with prediabetes, lasting at least three months, and reporting regression to normoglycemia rates. Using the number of participants that regressed to normoglycemia (fasting blood glucose <100 mg/dL, or two-hour post load glucose <140 mg/dL, or Hemoglobin A1c <5.7%) at the end of the intervention, we estimated the pooled risk difference (RD), number needed to treat (NNT) and relative risk using a Bayesian arm-based network meta-analysis.
Results: Fifty-one studies were included (25,440 participants, mean age 54 years, 46% male). Of these, 30 study arms tested lifestyle modification (LSM), 15 tested medications (60% glucose sensitizers), 8 tested medications+LSM, 8 tested dietary supplements (vitamins, minerals and herbs), and 7 tested supplements+LSM. Compared to control arms (n=29) at a mean 1.6 years of follow up [range 0.2-5.0], medications achieved the largest regression rates (RD=12%, NNT=8), followed by LSM (RD=6%, NNT=17), medications+LSM (RD=5%, NNT=20), and supplements (RD=2%, NNT=50 with or without LSM). The corresponding relative risks were 2.06 (1.39, 2.95) for medications, 1.76 (1.34, 2.36) for LSM, 2.36 (1.55, 3.52) for medications+LSM, 2.60 (1.74, 3.66) for supplements+LSM, and 1.67 (1.07, 2.55) for supplements.
Conclusion: Medications, glucose sensitizers in particular, are the most effective treatments for restoring normal glucose regulation in adults with prediabetes. LSM is also effective either alone or in combination with medications.
K.I. Galaviz: None. M. Weber: None. U. Gujral: None. J. Wei: None. K. Suvada: None. J. Haw: None. K. Narayan: None. M.K. Ali: Research Support; Self; Merck & Co., Inc.
National Heart, Lung, and Blood Institute (1K01HL149479-01); National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)