Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis
Lifestyle interventions improve the metabolic control of individuals with hyperglycemia. We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population. Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date...
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| Veröffentlicht in: | Diabetes care 2022-11, Vol.45 (11), p.2787-2795 |
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| creator | Zucatti, Kelly P Teixeira, Paula P Wayerbacher, Laura F Piccoli, Giovana F Correia, Poliana E Fonseca, Natasha K O Moresco, Karla S Guerra, Bruno A Maduré, Michelle G Farenzena, Laura P Frankenberg, Anize D Brietzke, Elisa Halpern, Bruno Franco, Oscar Colpani, Verônica Gerchman, Fernando |
| description | Lifestyle interventions improve the metabolic control of individuals with hyperglycemia.
We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population.
Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022).
We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention.
Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings.
Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79-1.23) or all-cause (RR 0.93; 95% CI 0.85-1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes.
Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results.
Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes. |
| doi_str_mv | 10.2337/dc22-0642 |
| format | Article |
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We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population.
Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022).
We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention.
Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings.
Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79-1.23) or all-cause (RR 0.93; 95% CI 0.85-1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes.
Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results.
Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/dc22-0642</identifier><identifier>PMID: 36318674</identifier><language>eng</language><publisher>United States: American Diabetes Association</publisher><subject>Bias ; Cardiovascular diseases ; Cardiovascular System ; Clinical trials ; Data search ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 ; Geographical distribution ; Geographical locations ; Heterogeneity ; Humans ; Hyperglycemia ; Life Style ; Lifestyles ; Meta-analysis ; Mortality ; Prediabetic State ; Quality ; Regression analysis ; Risk ; Statistical models ; Subgroups ; Systematic review</subject><ispartof>Diabetes care, 2022-11, Vol.45 (11), p.2787-2795</ispartof><rights>2022 by the American Diabetes Association.</rights><rights>Copyright American Diabetes Association Nov 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c348t-768779ae13cdd374dc258a83879ecff978bb085e1ce7ece0e20b0c7f840d5c823</citedby><cites>FETCH-LOGICAL-c348t-768779ae13cdd374dc258a83879ecff978bb085e1ce7ece0e20b0c7f840d5c823</cites><orcidid>0000-0001-7648-7378 ; 0000-0003-0973-5065 ; 0000-0001-5873-9498</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36318674$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zucatti, Kelly P</creatorcontrib><creatorcontrib>Teixeira, Paula P</creatorcontrib><creatorcontrib>Wayerbacher, Laura F</creatorcontrib><creatorcontrib>Piccoli, Giovana F</creatorcontrib><creatorcontrib>Correia, Poliana E</creatorcontrib><creatorcontrib>Fonseca, Natasha K O</creatorcontrib><creatorcontrib>Moresco, Karla S</creatorcontrib><creatorcontrib>Guerra, Bruno A</creatorcontrib><creatorcontrib>Maduré, Michelle G</creatorcontrib><creatorcontrib>Farenzena, Laura P</creatorcontrib><creatorcontrib>Frankenberg, Anize D</creatorcontrib><creatorcontrib>Brietzke, Elisa</creatorcontrib><creatorcontrib>Halpern, Bruno</creatorcontrib><creatorcontrib>Franco, Oscar</creatorcontrib><creatorcontrib>Colpani, Verônica</creatorcontrib><creatorcontrib>Gerchman, Fernando</creatorcontrib><title>Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis</title><title>Diabetes care</title><addtitle>Diabetes Care</addtitle><description>Lifestyle interventions improve the metabolic control of individuals with hyperglycemia.
We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population.
Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022).
We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention.
Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings.
Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79-1.23) or all-cause (RR 0.93; 95% CI 0.85-1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes.
Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results.
Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.</description><subject>Bias</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular System</subject><subject>Clinical trials</subject><subject>Data search</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2</subject><subject>Geographical distribution</subject><subject>Geographical locations</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Life Style</subject><subject>Lifestyles</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Prediabetic State</subject><subject>Quality</subject><subject>Regression analysis</subject><subject>Risk</subject><subject>Statistical models</subject><subject>Subgroups</subject><subject>Systematic review</subject><issn>0149-5992</issn><issn>1935-5548</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc9u1DAQhy0EokvhwAsgS1zgYHD8Z-1wWy0FKm0FokUcI8cZU6-ceLGdRXks3pCkXThwGmnmm0-j-SH0vKJvGOfqbWcZI3Qt2AO0qmouiZRCP0QrWomayLpmZ-hJzntKqRBaP0ZnfM0rvVZihX7v4vCDFEg9vnAObMHR4Z13kMsUAF8O8-gIQ_FxyDgOuNwC3prU-Xg02Y7BJGyGDm9CIFszZsBXMRUTfJkW0fXY7mdnxt99ucVfEnTetFAg3y3dTAfADL8_9d7hDb6ecoHeFG_xVzh6-HUHXkExxAwmTNnnp-iRMyHDs1M9R98-XNxsP5Hd54-X282OWC50IWqtlaoNVNx2HVdi_pHURnOtarDO1Uq3LdUSKgsKLFBgtKVWOS1oJ61m_By9uvceUvw5zv9oep8thGAGiGNumOKV4FRQPaMv_0P3cUzzvSdKSS4X4et7yqaYcwLXHJLvTZqaijZLjs2SY7PkOLMvTsax7aH7R_4Njv8BKcqZ0w</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Zucatti, Kelly P</creator><creator>Teixeira, Paula P</creator><creator>Wayerbacher, Laura F</creator><creator>Piccoli, Giovana F</creator><creator>Correia, Poliana E</creator><creator>Fonseca, Natasha K O</creator><creator>Moresco, Karla S</creator><creator>Guerra, Bruno A</creator><creator>Maduré, Michelle G</creator><creator>Farenzena, Laura P</creator><creator>Frankenberg, Anize D</creator><creator>Brietzke, Elisa</creator><creator>Halpern, Bruno</creator><creator>Franco, Oscar</creator><creator>Colpani, Verônica</creator><creator>Gerchman, Fernando</creator><general>American Diabetes Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7648-7378</orcidid><orcidid>https://orcid.org/0000-0003-0973-5065</orcidid><orcidid>https://orcid.org/0000-0001-5873-9498</orcidid></search><sort><creationdate>20221101</creationdate><title>Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis</title><author>Zucatti, Kelly P ; Teixeira, Paula P ; Wayerbacher, Laura F ; Piccoli, Giovana F ; Correia, Poliana E ; Fonseca, Natasha K O ; Moresco, Karla S ; Guerra, Bruno A ; Maduré, Michelle G ; Farenzena, Laura P ; Frankenberg, Anize D ; Brietzke, Elisa ; Halpern, Bruno ; Franco, Oscar ; Colpani, Verônica ; Gerchman, Fernando</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c348t-768779ae13cdd374dc258a83879ecff978bb085e1ce7ece0e20b0c7f840d5c823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Bias</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular System</topic><topic>Clinical trials</topic><topic>Data search</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2</topic><topic>Geographical distribution</topic><topic>Geographical locations</topic><topic>Heterogeneity</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Life Style</topic><topic>Lifestyles</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Prediabetic State</topic><topic>Quality</topic><topic>Regression analysis</topic><topic>Risk</topic><topic>Statistical models</topic><topic>Subgroups</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zucatti, Kelly P</creatorcontrib><creatorcontrib>Teixeira, Paula P</creatorcontrib><creatorcontrib>Wayerbacher, Laura F</creatorcontrib><creatorcontrib>Piccoli, Giovana F</creatorcontrib><creatorcontrib>Correia, Poliana E</creatorcontrib><creatorcontrib>Fonseca, Natasha K O</creatorcontrib><creatorcontrib>Moresco, Karla S</creatorcontrib><creatorcontrib>Guerra, Bruno A</creatorcontrib><creatorcontrib>Maduré, Michelle G</creatorcontrib><creatorcontrib>Farenzena, Laura P</creatorcontrib><creatorcontrib>Frankenberg, Anize D</creatorcontrib><creatorcontrib>Brietzke, Elisa</creatorcontrib><creatorcontrib>Halpern, Bruno</creatorcontrib><creatorcontrib>Franco, Oscar</creatorcontrib><creatorcontrib>Colpani, Verônica</creatorcontrib><creatorcontrib>Gerchman, Fernando</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetes care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zucatti, Kelly P</au><au>Teixeira, Paula P</au><au>Wayerbacher, Laura F</au><au>Piccoli, Giovana F</au><au>Correia, Poliana E</au><au>Fonseca, Natasha K O</au><au>Moresco, Karla S</au><au>Guerra, Bruno A</au><au>Maduré, Michelle G</au><au>Farenzena, Laura P</au><au>Frankenberg, Anize D</au><au>Brietzke, Elisa</au><au>Halpern, Bruno</au><au>Franco, Oscar</au><au>Colpani, Verônica</au><au>Gerchman, Fernando</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis</atitle><jtitle>Diabetes care</jtitle><addtitle>Diabetes Care</addtitle><date>2022-11-01</date><risdate>2022</risdate><volume>45</volume><issue>11</issue><spage>2787</spage><epage>2795</epage><pages>2787-2795</pages><issn>0149-5992</issn><eissn>1935-5548</eissn><abstract>Lifestyle interventions improve the metabolic control of individuals with hyperglycemia.
We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population.
Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022).
We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention.
Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings.
Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79-1.23) or all-cause (RR 0.93; 95% CI 0.85-1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes.
Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results.
Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.</abstract><cop>United States</cop><pub>American Diabetes Association</pub><pmid>36318674</pmid><doi>10.2337/dc22-0642</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7648-7378</orcidid><orcidid>https://orcid.org/0000-0003-0973-5065</orcidid><orcidid>https://orcid.org/0000-0001-5873-9498</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Diabetes care, 2022-11, Vol.45 (11), p.2787-2795 |
| issn | 0149-5992 1935-5548 |
| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Bias Cardiovascular diseases Cardiovascular System Clinical trials Data search Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 Geographical distribution Geographical locations Heterogeneity Humans Hyperglycemia Life Style Lifestyles Meta-analysis Mortality Prediabetic State Quality Regression analysis Risk Statistical models Subgroups Systematic review |
| title | Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis |
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