Meta-Analysis

. 2017 Jan:123:149-164.

doi: 10.1016/j.diabres.2016.11.020. Epub 2016 Dec 3.

Effect of lifestyle interventions on glucose regulation among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis

Xuanping Zhang¹, Giuseppina Imperatore², William Thomas³, Yiling J Cheng⁴, Felipe Lobelo⁵, Keri Norris⁶, Heather M Devlin⁷, Mohammed K Ali⁸, Stephanie Gruss⁹, Barbara Bardenheier¹⁰, Pyone Cho¹¹, Isabel Garcia de Quevedo¹², Uma Mudaliar¹³, Jinan Saaddine¹⁴, Linda S Geiss¹⁵, Edward W Gregg¹⁶

Affiliations

¹ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: xbz2@cdc.gov.
² Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: gai5@cdc.gov.
³ Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: bxt2@cdc.gov.
⁴ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: ycc1@cdc.gov.
⁵ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: felipelobelo@emory.edu.
⁶ Health Policy and Administration, Fulton-DeKalb Hospital Authority, Atlanta, GA, USA. Electronic address: dr.kerinorris@gmail.com.
⁷ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: jji3@cdc.gov.
⁸ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: mkali@emory.edu.
⁹ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: inf6@cdc.gov.
¹⁰ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: bfb7@cdc.gov.
¹¹ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: igz1@cdc.gov.
¹² Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: vpr5@cdc.gov.
¹³ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: umamudaliar@gmail.com.
¹⁴ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: zna2@cdc.gov.
¹⁵ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: lsg2@cdc.gov.
¹⁶ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: edg7@cdc.gov.

PMID: 28024276
PMCID: PMC6625761
DOI: 10.1016/j.diabres.2016.11.020

Meta-Analysis

Effect of lifestyle interventions on glucose regulation among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis

Xuanping Zhang et al. Diabetes Res Clin Pract. 2017 Jan.

. 2017 Jan:123:149-164.

doi: 10.1016/j.diabres.2016.11.020. Epub 2016 Dec 3.

Authors

Affiliations

¹ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: xbz2@cdc.gov.
² Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: gai5@cdc.gov.
³ Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: bxt2@cdc.gov.
⁴ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: ycc1@cdc.gov.
⁵ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: felipelobelo@emory.edu.
⁶ Health Policy and Administration, Fulton-DeKalb Hospital Authority, Atlanta, GA, USA. Electronic address: dr.kerinorris@gmail.com.
⁷ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: jji3@cdc.gov.
⁸ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: mkali@emory.edu.
⁹ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: inf6@cdc.gov.
¹⁰ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: bfb7@cdc.gov.
¹¹ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: igz1@cdc.gov.
¹² Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: vpr5@cdc.gov.
¹³ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: umamudaliar@gmail.com.
¹⁴ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: zna2@cdc.gov.
¹⁵ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: lsg2@cdc.gov.
¹⁶ Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: edg7@cdc.gov.

PMID: 28024276
PMCID: PMC6625761
DOI: 10.1016/j.diabres.2016.11.020

Abstract

This study systematically assessed the effectiveness of lifestyle interventions on glycemic indicators among adults (⩾18years) without IGT or diabetes. Randomized controlled trials using physical activity (PA), diet (D), or their combined strategies (PA+D) with follow-up ⩾12months were systematically searched from multiple electronic-databases between inception and May 4, 2016. Outcome measures included fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), fasting insulin (FI), homeostasis model assessment-estimated insulin resistance (HOMA-IR), and bodyweight. Included studies were divided into low-range (FPG <5.5mmol/L or HbA1c <5.5%) and high-range (FPG ⩾5.5mmol/L or HbA1c ⩾5.5%) groups according to baseline glycemic levels. Seventy-nine studies met inclusion criteria. Random-effect models demonstrated that compared with usual care, lifestyle interventions achieved significant reductions in FPG (-0.14mmol/L [95%CI, -0.19, -0.10]), HbA1c (-0.06% [-0.09, -0.03]), FI (%change: -15.18% [-20.01, -10.35]), HOMA-IR (%change: -22.82% [-29.14, -16.51]), and bodyweight (%change: -3.99% [-4.69, -3.29]). The same effect sizes in FPG reduction (0.07) appeared among both low-range and high-range groups. Similar effects were observed among all groups regardless of lengths of follow-up. D and PA+D interventions had larger effects on glucose reduction than PA alone. Lifestyle interventions significantly improved FPG, HbA1c, FI, HOMA-IR, and bodyweight among adults without IGT or diabetes, and might reduce progression of hyperglycemia to type 2 diabetes mellitus.

Keywords: Glucose regulation; Lifestyle intervention; Meta-analysis; Systematic review.

Published by Elsevier B.V.

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Conflict of interest statement

Conflicts of interest disclosures:

No actual or potential conflicts of interest exist.

Figures

**Fig. 1 --**
Study flow diagram. CINAHL, Cumulative Index to Nursing and Allied Health Literature. EMBASE, Excerpta Medica Database. MEDLINE, Medical Literature Analysis and Retrieval System Online. PsycInfo, Psychological Infomration Database. WOS, Web of Science.

**Fig. 2 --**
Changes in fasting plasma glucose in the intervention versus usual care groups (mmol/L). Group 1: low-range glycemic group (FPG <5.5mmol/L or HbA1c <5.5%). Group 2: high-range glycemic group (FPG ≥5.5 mmol/L or HbA1c ≥5.5%). D, diet. PA, physical activity. UC, usual care. vs versus.

See this image and copyright information in PMC

References

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Effect of lifestyle interventions on glucose regulation among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis

Affiliations

Effect of lifestyle interventions on glucose regulation among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous