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Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews
OBJECTIVES: To review the clinical outcomes of combined diet and physical activity interventions for populations at high risk of type 2 diabetes. DESIGN: Overview of systematic reviews (search dates April–December 2015). SETTING: Any level of care; no geographical restriction. PARTICIPANTS: Adults a...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223710/ https://www.ncbi.nlm.nih.gov/pubmed/28003299 http://dx.doi.org/10.1136/bmjopen-2016-013806 |
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author | Howells, Lara Musaddaq, Besma McKay, Ailsa J Majeed, Azeem |
author_facet | Howells, Lara Musaddaq, Besma McKay, Ailsa J Majeed, Azeem |
author_sort | Howells, Lara |
collection | PubMed |
description | OBJECTIVES: To review the clinical outcomes of combined diet and physical activity interventions for populations at high risk of type 2 diabetes. DESIGN: Overview of systematic reviews (search dates April–December 2015). SETTING: Any level of care; no geographical restriction. PARTICIPANTS: Adults at high risk of diabetes (as per measures of glycaemia, risk assessment or presence of risk factors). INTERVENTIONS: Combined diet and physical activity interventions including ≥2 interactions with a healthcare professional, and ≥12 months follow-up. OUTCOME MEASURES: Primary: glycaemia, diabetes incidence. Secondary: behaviour change, measures of adiposity, vascular disease and mortality. RESULTS: 19 recent reviews were identified for inclusion; 5 with AMSTAR scores <8. Most considered only randomised controlled trials (RCTs), and RCTs were the major data source in the remainder. Five trials were included in most reviews. Almost all analyses reported that interventions were associated with net reductions in diabetes incidence, measures of glycaemia and adiposity, at follow-up durations of up to 23 years (typically <6). Small effect sizes and potentially transient effect were reported in some studies, and some reviewers noted that durability of intervention impact was potentially sensitive to duration of intervention and adherence to behaviour change. Behaviour change, vascular disease and mortality outcome data were infrequently reported, and evidence of the impact of intervention on these outcomes was minimal. Evidence for age effect was mixed, and sex and ethnicity effect were little considered. CONCLUSIONS: Relatively long-duration lifestyle interventions can limit or delay progression to diabetes under trial conditions. However, outcomes from more time-limited interventions, and those applied in routine clinical settings, appear more variable, in keeping with the findings of recent pragmatic trials. There is little evidence of intervention impact on vascular outcomes or mortality end points in any context. ‘Real-world’ implementation of lifestyle interventions for diabetes prevention may be expected to lead to modest outcomes. |
format | Online Article Text |
id | pubmed-5223710 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-52237102017-01-13 Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews Howells, Lara Musaddaq, Besma McKay, Ailsa J Majeed, Azeem BMJ Open Public Health OBJECTIVES: To review the clinical outcomes of combined diet and physical activity interventions for populations at high risk of type 2 diabetes. DESIGN: Overview of systematic reviews (search dates April–December 2015). SETTING: Any level of care; no geographical restriction. PARTICIPANTS: Adults at high risk of diabetes (as per measures of glycaemia, risk assessment or presence of risk factors). INTERVENTIONS: Combined diet and physical activity interventions including ≥2 interactions with a healthcare professional, and ≥12 months follow-up. OUTCOME MEASURES: Primary: glycaemia, diabetes incidence. Secondary: behaviour change, measures of adiposity, vascular disease and mortality. RESULTS: 19 recent reviews were identified for inclusion; 5 with AMSTAR scores <8. Most considered only randomised controlled trials (RCTs), and RCTs were the major data source in the remainder. Five trials were included in most reviews. Almost all analyses reported that interventions were associated with net reductions in diabetes incidence, measures of glycaemia and adiposity, at follow-up durations of up to 23 years (typically <6). Small effect sizes and potentially transient effect were reported in some studies, and some reviewers noted that durability of intervention impact was potentially sensitive to duration of intervention and adherence to behaviour change. Behaviour change, vascular disease and mortality outcome data were infrequently reported, and evidence of the impact of intervention on these outcomes was minimal. Evidence for age effect was mixed, and sex and ethnicity effect were little considered. CONCLUSIONS: Relatively long-duration lifestyle interventions can limit or delay progression to diabetes under trial conditions. However, outcomes from more time-limited interventions, and those applied in routine clinical settings, appear more variable, in keeping with the findings of recent pragmatic trials. There is little evidence of intervention impact on vascular outcomes or mortality end points in any context. ‘Real-world’ implementation of lifestyle interventions for diabetes prevention may be expected to lead to modest outcomes. BMJ Publishing Group 2016-12-21 /pmc/articles/PMC5223710/ /pubmed/28003299 http://dx.doi.org/10.1136/bmjopen-2016-013806 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Public Health Howells, Lara Musaddaq, Besma McKay, Ailsa J Majeed, Azeem Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews |
title | Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews |
title_full | Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews |
title_fullStr | Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews |
title_full_unstemmed | Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews |
title_short | Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews |
title_sort | clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews |
topic | Public Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223710/ https://www.ncbi.nlm.nih.gov/pubmed/28003299 http://dx.doi.org/10.1136/bmjopen-2016-013806 |
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