Effects of Different Dietary and Lifestyle Modification Therapies on Metabolic Syndrome in Prediabetic Arab Patients: A 12-Month Longitudinal Study

Abstract

This three-arm, randomized, controlled study aimed to determine the differences in the effects of general advice (GA) on lifestyle change, intensive lifestyle modification programme (ILMP) and GA + metformin (GA + Met) in reducing the prevalence of full metabolic syndrome (MetS) in subjects with prediabetes; 294 Saudis with prediabetes (fasting glucose 5.6-6.9 mmol/L) were initially randomized, 263 completed 6 months and 237 completed 12 months. They were allocated into three groups: GA group which received a standard lifestyle change education; ILMP which followed a rigorous lifestyle modification support on diet and physical activity; and a GA + Met group. Anthropometric and biochemical estimations were measured. Full MetS (primary endpoint) and its components (secondary endpoint) were screened at baseline, 6 and 12 months. Full MetS in the ILMP group decreased by 26% (p < 0.001); in GA + Met group by 22.4% (p = 0.01) and in GA group by 8.2% (p = 0.28). The number of MetS components decreased significantly in the ILMP and GA + Met groups (mean change 0.81, p < 0.001 and 0.35, p = 0.05, respectively). Between-group comparison revealed a clinically significant decrease in MetS components in favor of the ILMP group (-0.58 (-0.88-0.28), p < 0.001). This study highlights the clinical potency of ILMP versus other diabetes prevention options in reducing MetS in Saudi adults with elevated fasting glucose.

Keywords: impaired glucose regulation; lifestyle modifications; metabolic syndrome; metformin; type 2 diabetes.

Figure 1

Flow chart detailing the participation of subjects and their allocation to treatment groups.

Figure 2

Odds ratio (OR) of MetS and its components for three treatment groups. The model is adjusted for age, sex, BMI and baseline covariates: waist, systolic and diastolic BP, fasting glucose, HbA1c, and vitamin D.

Figure 3

Intervention effects in total number of MetS components (A) and MetS risk-score (B) for three treatment strategies calculated at baseline and follow-up. Data is adjusted for age, sex and BMI, systolic and diastolic BP, waist, fasting glucose, HbA1c, and vitamin D (all baseline values). The overall change in ILMP and GA + Met groups versus GA group reported as Mean Change (95% confidence interval). Within group intervention effect is shown as * for p < 0.05 or ** for p < 0.01.