Review and special articles
Long-term effectiveness of weight-loss interventions in adults with pre-diabetes: A review

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Objective

To assess the effectiveness of weight-loss and weight-control interventions for adults with pre-diabetes (impaired fasting glucose and impaired glucose tolerance), an important risk factor for the development of type 2 diabetes.

Methods

Computerized searches were conducted of multiple electronic bibliographic databases up to August 2003. Randomized controlled trials in any language were selected that examined weight-loss or weight-control strategies using at least one dietary, physical activity, or behavioral intervention, and with a follow-up interval of ≥12 months. Effects were combined using a random effects model.

Results

Studies were identified, with a total of 5168 participants. Follow-up ranged from 1 to 10 years. Quantitative synthesis was limited by the heterogeneity of populations, settings, and interventions, and by the small number of studies that examined outcomes other than weight. Overall, compared to usual care, four studies with a follow-up of 1 year reduced weight by 2.8 kg (95% confidence interval [CI]=1.0–4.7) (3.3% of baseline body weight) and decreased body mass index by 1.4 kg/m2 (CI=0.5–2.3). Weight loss at 2 years was 2.7 kg (CI=1.9–3.4) (two studies). Modest improvements were noted in the few studies that examined glycemic control, blood pressure, and lipid concentrations (p >0.05). The incidence of diabetes was significantly lower in the intervention groups versus the controls in three of five studies examining this outcome at 3 to 6 years follow-up.

Conclusions

Overall, weight-loss strategies using dietary, physical activity, or behavioral interventions produced significant improvements in weight among persons with pre-diabetes, and a significant decrease in diabetes incidence. Further work is needed on the long-term effects of these interventions on morbidity and mortality and on how to implement these interventions in the community setting.

Section snippets

Data sources

Following the Cochrane Collaboration’s methods,13 a systematic review protocol was developed. In consultation with a medical research librarian, search strategies were devised using an iterative process that involved medical subject headings (MeSH) and text words. The following databases were searched between the date indicated and August 2003: MEDLINE (1966), EMBASE (1980), CINAHL (1982), ERIC (1966), PsychInfo (1967), Web of Science (1981), Biosis (1969), Nutrition Abstracts and Reviews

Results

Nine eligible RCTs were identified in the published literature10, 11, 21, 22, 23, 24, 25, 26, 27 (Table 1). These were all weight-loss studies among overweight or obese people with pre-diabetes. No unpublished studies were identified and no studies focused exclusively on weight control. The study flow diagram is available from the authors. The studies included a total of 5168 participants (range, 31 to 3234) and the follow-up interval averaged 3.2 years. The study populations varied somewhat in

Discussion and conclusions

Randomized controlled trials of weight-loss interventions using dietary, physical activity, or behavioral interventions produced statistically significant between-group weight loss of 2 to 3 kg (3% of initial body weight) at 1- and 2-year follow-ups. In two studies where weight was examined at longer follow-up intervals (up to 10 years), similar weight reduction was maintained. The number of intervention contacts with subjects was significantly correlated with weight loss. Data are limited, but

References (58)

  • Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications

    Diabetes Care

    (2003)
  • C.A. Maggio et al.

    The prevention and treatment of obesityapplication to type 2 diabetes

    Diabetes Care

    (1997)
  • R.R. Wing et al.

    Long-term effects of modest weight loss in type II diabetic patients

    Arch Intern Med

    (1987)
  • R.R. Wing et al.

    Effects of a very-low-calorie diet on long-term glycemic control in obese type 2 diabetic subjects

    Arch Intern Med

    (1991)
  • D.F. Williamson et al.

    Intentional weight loss and mortality among overweight individuals with diabetes

    Diabetes Care

    (2000)
  • R.R. Wing et al.

    Behavior change, weight loss, and physiological improvements in type II diabetic patients

    J Consult Clin Psychol

    (1985)
  • Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

    N Engl J Med

    (2002)
  • J. Tuomilehto et al.

    Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance

    N Engl J Med

    (2001)
  • The prevention or delay of type 2 diabetes

    Diabetes Care

    (2003)
  • M. Clarke et al.

    Cochrane reviewers handbook (updated October 2001)

    (2001)
  • Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus

    Diabetes Care

    (2003)
  • National Heart Lung and Blood Institute, National Institutes of Health

    Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adultsthe evidence report

    (1998)
  • A.R. Feinstein

    Clinical epidemiologythe architecture of clinical research

    (1985)
  • G.S. Rhiel

    The effect of non-normality on the use of the range in estimating the population standard deviation

    J Stat Comput

    (1986)
  • R. DerSimonian et al.

    Meta-analysis in clinical trials

    Control Clin Trials

    (1954)
  • W.G. Cochran

    The combination of estimates from different experiments

    Biometrics

    (1954)
  • R.J. Jarrett et al.

    Changes in blood pressure and body weight over ten years in men selected for glucose intolerance

    J Epidemiol Community Health

    (1987)
  • D. Liao et al.

    Improvement of BMI, body composition, and body fat distribution with lifestyle modification in Japanese Americans with impaired glucose tolerance

    Diabetes Care

    (2002)
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