Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis
Objective To quantify the effectiveness of pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance. Data sources Medline, Embase, and the Cochrane library searched up to July 2006. Expert opinions sought and reference lists of identif...
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| Veröffentlicht in: | BMJ 2007-02, Vol.334 (7588), p.299-302 |
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| creator | Gillies, Clare L Abrams, Keith R Lambert, Paul C Cooper, Nicola J Sutton, Alex J Hsu, Ron T Khunti, Kamlesh |
| description | Objective To quantify the effectiveness of pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance. Data sources Medline, Embase, and the Cochrane library searched up to July 2006. Expert opinions sought and reference lists of identified studies and any relevant published reviews checked. Study selection Randomised controlled trials that evaluated interventions to delay or prevent type 2 diabetes in individuals with impaired glucose tolerance. Results 21 trials met the inclusion criteria, of which 17, with 8084 participants with impaired glucose tolerance, reported results in enough detail for inclusion in the meta-analyses. From the meta-analyses the pooled hazard ratios were 0.51 (95% confidence interval 0.44 to 0.60) for lifestyle interventions v standard advice, 0.70 (0.62 to 0.79) for oral diabetes drugs v control, 0.44 (0.28 to 0.69) for orlistat v control, and 0.32 (0.03 to 3.07) for the herbal remedy jiangtang bushen recipe v standard diabetes advice. These correspond to numbers needed to treat for benefit (NNTB) and harm (NNTH) of 6.4 for lifestyle (95% credible interval, NNTB 5.0 to NNTB 8.4), 10.8 for oral diabetes drugs (NNTB 8.1 to NNTB 15.0), 5.4 for orlistat (NNTB 4.1 to NNTB 7.6), and 4.0 for jiangtang bushen (NNTH 16.9 to NNTB 24.8). Conclusions Lifestyle and pharmacological interventions reduce the rate of progression to type 2 diabetes in people with impaired glucose tolerance. Lifestyle interventions seem to be at least as effective as drug treatment. |
| doi_str_mv | 10.1136/bmj.39063.689375.55 |
| format | Article |
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Data sources Medline, Embase, and the Cochrane library searched up to July 2006. Expert opinions sought and reference lists of identified studies and any relevant published reviews checked. Study selection Randomised controlled trials that evaluated interventions to delay or prevent type 2 diabetes in individuals with impaired glucose tolerance. Results 21 trials met the inclusion criteria, of which 17, with 8084 participants with impaired glucose tolerance, reported results in enough detail for inclusion in the meta-analyses. From the meta-analyses the pooled hazard ratios were 0.51 (95% confidence interval 0.44 to 0.60) for lifestyle interventions v standard advice, 0.70 (0.62 to 0.79) for oral diabetes drugs v control, 0.44 (0.28 to 0.69) for orlistat v control, and 0.32 (0.03 to 3.07) for the herbal remedy jiangtang bushen recipe v standard diabetes advice. These correspond to numbers needed to treat for benefit (NNTB) and harm (NNTH) of 6.4 for lifestyle (95% credible interval, NNTB 5.0 to NNTB 8.4), 10.8 for oral diabetes drugs (NNTB 8.1 to NNTB 15.0), 5.4 for orlistat (NNTB 4.1 to NNTB 7.6), and 4.0 for jiangtang bushen (NNTH 16.9 to NNTB 24.8). Conclusions Lifestyle and pharmacological interventions reduce the rate of progression to type 2 diabetes in people with impaired glucose tolerance. Lifestyle interventions seem to be at least as effective as drug treatment.</description><edition>International edition</edition><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 0959-8146</identifier><identifier>ISSN: 0959-535X</identifier><identifier>EISSN: 1468-5833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.39063.689375.55</identifier><identifier>PMID: 17237299</identifier><identifier>CODEN: BMJOAE</identifier><language>eng</language><publisher>London: British Medical Journal Publishing Group</publisher><subject>Biological and medical sciences ; Body mass index ; Changes ; Diabetes ; Diabetes Mellitus, Type 2 - therapy ; Diabetes. Impaired glucose tolerance ; Diabetic diets ; Diet ; Drug therapy ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Experimentation ; General aspects ; Glucose ; Glucose Intolerance - therapy ; Humans ; Hypoglycemic Agents - therapeutic use ; Intervention ; Life Style ; Lifestyle ; Lifestyles ; Medical research ; Medical sciences ; Meta analysis ; Pharmacology ; Prediabetic state ; Prevention ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Publication Bias ; Randomized Controlled Trials as Topic ; Risk factors ; Studies ; Treatment ; Treatment Outcome ; Type 2 diabetes mellitus</subject><ispartof>BMJ, 2007-02, Vol.334 (7588), p.299-302</ispartof><rights>BMJ Publishing Group Ltd 2007</rights><rights>Copyright 2007 BMJ Publishing Group Ltd.</rights><rights>2007 INIST-CNRS</rights><rights>Copyright: 2007 (c) BMJ Publishing Group Ltd 2007</rights><rights>Copyright BMJ Publishing Group Feb 10, 2007</rights><rights>BMJ Publishing Group Ltd 2007 2007 BMJ Publishing Group Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b618t-c763ba2d7ffd235974f15f1a5a47cb6aeb96df5fa27095ad0f37f43fb5263f243</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/334/7588/299.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://bmj.com/content/334/7588/299.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,230,314,780,784,803,885,3196,23571,27924,27925,30999,31000,58017,58250,77600,77631</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18501839$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17237299$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gillies, Clare L</creatorcontrib><creatorcontrib>Abrams, Keith R</creatorcontrib><creatorcontrib>Lambert, Paul C</creatorcontrib><creatorcontrib>Cooper, Nicola J</creatorcontrib><creatorcontrib>Sutton, Alex J</creatorcontrib><creatorcontrib>Hsu, Ron T</creatorcontrib><creatorcontrib>Khunti, Kamlesh</creatorcontrib><title>Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis</title><title>BMJ</title><addtitle>BMJ</addtitle><description>Objective To quantify the effectiveness of pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance. Data sources Medline, Embase, and the Cochrane library searched up to July 2006. Expert opinions sought and reference lists of identified studies and any relevant published reviews checked. Study selection Randomised controlled trials that evaluated interventions to delay or prevent type 2 diabetes in individuals with impaired glucose tolerance. Results 21 trials met the inclusion criteria, of which 17, with 8084 participants with impaired glucose tolerance, reported results in enough detail for inclusion in the meta-analyses. From the meta-analyses the pooled hazard ratios were 0.51 (95% confidence interval 0.44 to 0.60) for lifestyle interventions v standard advice, 0.70 (0.62 to 0.79) for oral diabetes drugs v control, 0.44 (0.28 to 0.69) for orlistat v control, and 0.32 (0.03 to 3.07) for the herbal remedy jiangtang bushen recipe v standard diabetes advice. These correspond to numbers needed to treat for benefit (NNTB) and harm (NNTH) of 6.4 for lifestyle (95% credible interval, NNTB 5.0 to NNTB 8.4), 10.8 for oral diabetes drugs (NNTB 8.1 to NNTB 15.0), 5.4 for orlistat (NNTB 4.1 to NNTB 7.6), and 4.0 for jiangtang bushen (NNTH 16.9 to NNTB 24.8). Conclusions Lifestyle and pharmacological interventions reduce the rate of progression to type 2 diabetes in people with impaired glucose tolerance. Lifestyle interventions seem to be at least as effective as drug treatment.</description><subject>Biological and medical sciences</subject><subject>Body mass index</subject><subject>Changes</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diabetic diets</subject><subject>Diet</subject><subject>Drug therapy</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Experimentation</subject><subject>General aspects</subject><subject>Glucose</subject><subject>Glucose Intolerance - therapy</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Intervention</subject><subject>Life Style</subject><subject>Lifestyle</subject><subject>Lifestyles</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Meta analysis</subject><subject>Pharmacology</subject><subject>Prediabetic state</subject><subject>Prevention</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Publication Bias</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk factors</subject><subject>Studies</subject><subject>Treatment</subject><subject>Treatment Outcome</subject><subject>Type 2 diabetes mellitus</subject><issn>0959-8138</issn><issn>0959-8146</issn><issn>0959-535X</issn><issn>1468-5833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkmuL1DAUhoso7rDuLxAlKPqtY9I0SeMHQQZvsF4WV_0YTttkJmPb1KSza_-Mv9V0O8yqIAqBppznvOeSN0nuErwkhPInZbtdUok5XfJCUsGWjN1IFiTnRcoKSm8mCyyZTAtCi6PkJIQtxjijopCc3U6OiIj3TMpF8uPDBnwLlWvc2lbQIOhq1FijwzA2Gtlu0P5Cd4N1XUCDQ73X0y9yHtW6gRENY69RhmoLpR50iBmo166PuZd22CDb9mC9rtG62VUu6KjRaA9dpZ-iMIZBtzDYCkVVqy-vird6gBQ6aMZgw53kloEm6JP99zj59PLF-ep1evr-1ZvV89O05KQY0kpwWkJWC2PqjDIpckOYIcAgF1XJQZeS14YZyERcC9TYUGFyakqWcWqynB4nz2bdfle2uq7iiB4a1Xvbgh-VA6t-j3R2o9buQhEhOZcsCjzeC3j3bRe3p1obKt000Gm3Cyq-Utw9xv8EmSCsiCeCD_4At27n416CynCOSRFnidDDv0FECCFlRoqJojNVeReC1-YwGMFqspOKdlJXdlKznRSbRrr_606uc_bmicCjPQAhWsdMz2rDNVew2CWduHsztw2D84d4hlksmE-F0jluox--H-LgvyoupmbefV6pjJx_PFt9eavOIr-c-anr_5nkJxA0_kY</recordid><startdate>20070210</startdate><enddate>20070210</enddate><creator>Gillies, Clare L</creator><creator>Abrams, Keith R</creator><creator>Lambert, Paul C</creator><creator>Cooper, Nicola J</creator><creator>Sutton, Alex J</creator><creator>Hsu, Ron T</creator><creator>Khunti, Kamlesh</creator><general>British Medical Journal Publishing Group</general><general>British Medical Association</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><general>BMJ Publishing Group Ltd</general><scope>BSCLL</scope><scope>IQODW</scope><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>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7QJ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20070210</creationdate><title>Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis</title><author>Gillies, Clare L ; Abrams, Keith R ; Lambert, Paul C ; Cooper, Nicola J ; Sutton, Alex J ; Hsu, Ron T ; Khunti, Kamlesh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b618t-c763ba2d7ffd235974f15f1a5a47cb6aeb96df5fa27095ad0f37f43fb5263f243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Biological and medical sciences</topic><topic>Body mass index</topic><topic>Changes</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - therapy</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Diabetic diets</topic><topic>Diet</topic><topic>Drug therapy</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Experimentation</topic><topic>General aspects</topic><topic>Glucose</topic><topic>Glucose Intolerance - therapy</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Intervention</topic><topic>Life Style</topic><topic>Lifestyle</topic><topic>Lifestyles</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Meta analysis</topic><topic>Pharmacology</topic><topic>Prediabetic state</topic><topic>Prevention</topic><topic>Prevention and actions</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Publication Bias</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk factors</topic><topic>Studies</topic><topic>Treatment</topic><topic>Treatment Outcome</topic><topic>Type 2 diabetes mellitus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gillies, Clare L</creatorcontrib><creatorcontrib>Abrams, Keith R</creatorcontrib><creatorcontrib>Lambert, Paul C</creatorcontrib><creatorcontrib>Cooper, Nicola J</creatorcontrib><creatorcontrib>Sutton, Alex J</creatorcontrib><creatorcontrib>Hsu, Ron T</creatorcontrib><creatorcontrib>Khunti, Kamlesh</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gillies, Clare L</au><au>Abrams, Keith R</au><au>Lambert, Paul C</au><au>Cooper, Nicola J</au><au>Sutton, Alex J</au><au>Hsu, Ron T</au><au>Khunti, Kamlesh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis</atitle><jtitle>BMJ</jtitle><addtitle>BMJ</addtitle><date>2007-02-10</date><risdate>2007</risdate><volume>334</volume><issue>7588</issue><spage>299</spage><epage>302</epage><pages>299-302</pages><issn>0959-8138</issn><issn>0959-8146</issn><issn>0959-535X</issn><eissn>1468-5833</eissn><eissn>1756-1833</eissn><coden>BMJOAE</coden><abstract>Objective To quantify the effectiveness of pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance. Data sources Medline, Embase, and the Cochrane library searched up to July 2006. Expert opinions sought and reference lists of identified studies and any relevant published reviews checked. Study selection Randomised controlled trials that evaluated interventions to delay or prevent type 2 diabetes in individuals with impaired glucose tolerance. Results 21 trials met the inclusion criteria, of which 17, with 8084 participants with impaired glucose tolerance, reported results in enough detail for inclusion in the meta-analyses. From the meta-analyses the pooled hazard ratios were 0.51 (95% confidence interval 0.44 to 0.60) for lifestyle interventions v standard advice, 0.70 (0.62 to 0.79) for oral diabetes drugs v control, 0.44 (0.28 to 0.69) for orlistat v control, and 0.32 (0.03 to 3.07) for the herbal remedy jiangtang bushen recipe v standard diabetes advice. These correspond to numbers needed to treat for benefit (NNTB) and harm (NNTH) of 6.4 for lifestyle (95% credible interval, NNTB 5.0 to NNTB 8.4), 10.8 for oral diabetes drugs (NNTB 8.1 to NNTB 15.0), 5.4 for orlistat (NNTB 4.1 to NNTB 7.6), and 4.0 for jiangtang bushen (NNTH 16.9 to NNTB 24.8). Conclusions Lifestyle and pharmacological interventions reduce the rate of progression to type 2 diabetes in people with impaired glucose tolerance. Lifestyle interventions seem to be at least as effective as drug treatment.</abstract><cop>London</cop><pub>British Medical Journal Publishing Group</pub><pmid>17237299</pmid><doi>10.1136/bmj.39063.689375.55</doi><tpages>4</tpages><edition>International edition</edition><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Body mass index Changes Diabetes Diabetes Mellitus, Type 2 - therapy Diabetes. Impaired glucose tolerance Diabetic diets Diet Drug therapy Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Experimentation General aspects Glucose Glucose Intolerance - therapy Humans Hypoglycemic Agents - therapeutic use Intervention Life Style Lifestyle Lifestyles Medical research Medical sciences Meta analysis Pharmacology Prediabetic state Prevention Prevention and actions Public health. Hygiene Public health. Hygiene-occupational medicine Publication Bias Randomized Controlled Trials as Topic Risk factors Studies Treatment Treatment Outcome Type 2 diabetes mellitus |
| title | Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis |
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