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OBJECTIVE - To evaluate the efficacy of lifestyle education for preventing type 2 diabetes in individuals at high risk by meta-analysis of randomized controlled trials, as assessed by incidence and a reduced level of plasma glucose 2 h after a 75-g oral glucose load (2-h plasma glucose).
RESEARCH DESIGN AND METHODS - Through an electronic search, 123 studies were identified. A literature search identified eight studies that met strict inclusion criterion of meta-analysis for 2-h plasma glucose and five studies for the incidence of diabetes. All were randomized controlled trials of ≥6 months with lifestyle education that included a dietary intervention. Subjects were adults diagnosed as being at high risk for type 2 diabetes. The difference in mean reduction of 2-h plasma glucose from baseline to the 1-year follow-up and relative risk (RR) of the incidence of diabetes in the lifestyle education group versus the control group were assessed. Overall estimates were calculated using a random-effects model. Those estimates were confirmed by several models, and the possibility of selection bias was examined using a funnel plot.
RESULTS - Lifestyle education intervention reduced 2-h plasma glucose by 0.84 mmol/l (95% CI 0.39-1.29) compared with the control group. The 1-year incidence of diabetes was reduced by ~50% (RR 0.55,95% CI 0.44-0.69) compared with the control group. Results were stable and little changed if data were analyzed by subgroups or other statistical models. Funnel plots revealed no selection bias.
CONCLUSIONS - Lifestyle education was effective for reducing both 2-h plasma glucose and RR in high-risk individuals and may be a useful tool in preventing diabetes.
Diabetes Care 28:2780-2786, 2005
Abbreviations: DPPRG, Diabetes Prevention Program Research Group; IFG, impaired fasting glucose; IGT, impaired glucose tolerance.
Type 2 diabetes is increasing worldwide largely as a result of increasing obesity and a sedentary lifestyle. Nutritional therapy for diabetic patients was recommended by the American Diabetes Association (1). Considering the severity of the illness and low quality of life among diabetic patients, primary prevention for the development of type 2 diabetes is important. For this purpose, lifestyle education (combined diet and exercise) can be considered a powerful tool. Beginning with the impressive study in Da Qing, China (2), the benefits of lifestyle modification have been assessed. Some recent studies based on...