Lifestyle and medication interventions for the prevention or delay of type 2 diabetes mellitus in prediabetes: a systematic review of randomised controlled trials

Abstract

Objective: To assess lifestyle and pharmacological interventions aiming to delay type 2 diabetes mellitus (T2DM) in prediabetes.

Methods: We searched the Cochrane Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, BIOSIS and LILACS databases, examined reference lists and contacted authors. We included randomised controlled trials (RCTs) on both lifestyle and medication interventions in prediabetes. These studies were at least 12 month duration and aimed to delay T2DM.

Results: Four studies investigating lifestyle and medication with a total of 5,196 participants were identified. There was a high risk of bias in the studies and the interventions utilised varied considerably; thus, meta-analysis was not undertaken. The comparison between lifestyle and medication interventions was largely dependent on the intensity of the lifestyle program while we could not adequately assess their effects on cardiovascular morbidity. Adverse events with metformin and acarbose were common.

Conclusion: There is substantial evidence that intensive lifestyle programs and medications delay T2DM in impaired glucose tolerance though it remains unclear which is more effective.

Implications: Both interventions seem to be able to delay T2DM. However, both have issues with adherence and side effects and more RCTs are required.