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

doi:10.1136/bmj.39063.689375.55

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 effectivenessof pharmacological and lifestyle interventions to prevent ordelay type 2 diabetes in people with impaired glucose tolerance.

Data sources Medline, Embase,and the Cochrane library searched up to July 2006. Expert opinionssought and reference lists of identified studies and any relevantpublished reviews checked.

Study selection Randomised controlledtrials that evaluated interventions to delay or prevent type2 diabetes in individuals with impaired glucose tolerance.

Results 21 trials met the inclusioncriteria, of which 17, with 8084 participants with impairedglucose tolerance, reported results in enough detail for inclusionin the meta-analyses. From the meta-analyses the pooled hazardratios were 0.51 (95% confidence interval 0.44 to 0.60) forlifestyle 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 orlistatv control, and 0.32 (0.03 to 3.07) for the herbal remedy jiangtangbushen recipe v standard diabetes advice. These correspond tonumbers needed to treat for benefit (NNTB) and harm (NNTH) of6.4 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 fororlistat (NNTB 4.1 to NNTB 7.6), and 4.0 for jiangtang bushen(NNTH 16.9 to NNTB 24.8).

Conclusions Lifestyle and pharmacologicalinterventions reduce the rate of progression to type 2 diabetesin people with impaired glucose tolerance. Lifestyle interventionsseem to be at least as effective as drug treatment.

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Rapid Responses:

Read all Rapid Responses

Glucose values should be reported: Ingrid M�hlhauser
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 M�hlhauser
bmj.com, 28 Feb 2007 [Full text]