Long-term RCTs have shown that lifestyle interventions (LI) can prevent T2DM in individuals with prediabetes, improve glycemic control in individuals with T2DM, as well as improve lipid profile and lower blood pressure in both. However, the impact of these interventions on cardiovascular (CV) and total mortality is still not clear. Therefore, we conducted a systematic review with meta-analysis to determine the long-term efficacy of LI on CV and all-cause mortality in subjects with prediabetes and T2DM. We searched PubMed, Cochrane CENTRAL, Embase, Web of Science, protocol records, and reference lists of relevant publications until December 2021. We selected RCTs including adults with prediabetes and T2DM that evaluated LI with at least 2 years of duration, with or without post-trial follow-up. The main outcomes consisted of CV and all-cause mortality. We used the RoB 2.0 tool to evaluate the risk of bias and the GRADE approach for the overall certainty of evidence. Meta-analysis was conducted using a random effects method. We identified 22,900 records, of which studies registred all-cause mortality events (16,554 participants, mean age 55.5 years, mean BMI 30.5 Kg/m2, 9.9 years of follow-up) , and 5 reported CV mortality events (11,017 participants, mean age 54.5 years, and mean BMI 31.8 Kg/m2, 14.8 years of follow-up) . LI did not reduce the risk of CV mortality (RR 0.95; 95% CI 0.74 to 1.21; I2=38%; moderate certainty of the evidence) and all-cause mortality (RR 0.94; 95% CI 0.85 to 1.03; I2=15%; high certainty of the evidence) compared with usual care. This meta-analysis of RCTs demonstrated that intensive LI was not superior to usual care in reducing CV and all-cause mortality for subjects with prediabetes and T2DM. However, there is still insufficient evidence demonstrating the effect of long-term cardioprotective LI on mortality in this specific population.


K.P.Zucatti: None. N.Fonseca: None. P.Correia: None. E.Brietzke: Speaker's Bureau; Daiichi Sankyo, Janssen Pharmaceuticals, Inc. B.Halpern: None. V.Colpani: None. F.Gerchman: None. P.P.Teixeira: None. L.F.Wayerbacher: None. A.D.Frankenberg: None. B.A.Guerra: None. G.F.Piccoli: None. K.S.Moresco: None. L.Farenzena: None. M.G.Madure: None.

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