BMJ  2007;334:299 (10 February), doi:10.1136/bmj.39063.689375.55 (published 19 January 2007)

Research

Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis

Clare L Gillies, medical statistician1, Keith R Abrams, professor of medical statistics1, Paul C Lambert, senior lecturer in medical statistics1, Nicola J Cooper, MRC senior training fellow in health services research1, Alex J Sutton, reader in medical statistics1, Ron T Hsu, clinical senior teaching fellow in epidemiology and public health1, Kamlesh Khunti, clinical senior lecturer2

1 Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, 2 Clinical Division of General Practice and Primary Health Care, Department of Health Sciences, University of Leicester

Correspondence to: C L Gillies clg13{at}le.ac.uk

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.


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Rapid Responses:

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Glucose values should be reported
Ingrid Mühlhauser
bmj.com, 14 Feb 2007 [Full text]
Lifestyle Changes and/or Drugs for overweight patients without obesity ?
PATRICE COUZIGOU, et al.
bmj.com, 15 Feb 2007 [Full text]
Re: Glucose values should be reported
Clare L Gillies, et al.
bmj.com, 23 Feb 2007 [Full text]
Re: Lifestyle Changes and/or Drugs for overweight patients without obesity ?
Clare L Gillies, et al.
bmj.com, 23 Feb 2007 [Full text]
Re: Re: Glucose values should be reported
Ingrid Mühlhauser
bmj.com, 28 Feb 2007 [Full text]
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