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Using Lifestyle or Drug Interventions to Prevent or Delay Progression to Type 2 Diabetes

In a meta-analysis, researchers found that three interventions provided benefit.

Both drug therapies and lifestyle modifications can prevent or delay progression to type 2 diabetes in people with glucose intolerance (see, for example, Journal Watch Feb 19 2002). This British systematic review compared the effectiveness of pharmacologic and lifestyle interventions.

Researchers identified 17 randomized trials involving 8084 participants with glucose intolerance: 12 trials evaluated lifestyle interventions (mainly exercise and weight loss), 12 evaluated pharmacologic interventions (mainly metformin and acarbose), and several of them evaluated both. Most patients were followed for about 4 years. The pooled hazard ratios for developing diabetes were 0.51 with lifestyle intervention, 0.70 with oral diabetes drugs, and, and 0.44 for the weight-loss drug orlistat. All of these results were statistically significant and translated to a number needed to treat for benefit of 6.4 for lifestyle interventions, 10.8 for oral diabetes drugs, and 5.4 for orlistat.

Comment: This analysis confirms that several interventions can delay the progression to type 2 diabetes. However, the authors note that the protective effect lasted only as long as the intervention was in place — indicating that these interventions require long-term use to be truly effective.

— Keith I. Marton, MD

Published in Journal Watch General Medicine February 20, 2007

Citation(s):

Gillies CL et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: Systematic review and meta-analysis. BMJ 2007 Feb 10; 334:299. (http://dx.doi.org/10.1136/bmj.39063.689375.55)

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• Medline abstract (Free)