Which intervention is optimal to control blood glucose and improve physical performance in the elderly living with type 2 diabetes mellitus? A network meta-analysis

Abstract

Background and objectives: This study aimed to find the optimal intervention available to both control blood glucose and improve physical function in the geriatric population with T2DM.

Methods and study design: A systemic review and network meta-analysis (NMA) was conducted to assess and rank the comparative efficacy of different interventions on glycosylated hemoglobin A1c (HbAc1), fasting blood glucose (FBG), muscle mass, grip strength, gait speed, lower body muscle strength, and dynamic balance. A total of eight databases were searched for eligible randomized controlled trials (RCTs) that the elderly aged more than 60 years or with mean age ≥ 55 years, the minimal duration of the RCT intervention was 6 weeks, and those lacking data about glycemic level and at least one indicator of physical performance were excluded. The Cochrane risk of bias tool was used to assess the bias of each study included. Bayesian NMA was performed as the main results, the Bayesian meta regression and the frequentist NMA as sensitivity analysis.

Results: Of the 2266 literature retrieved, 27 RCTs with a total of 2289 older adults were included. Health management provided by health workers exerts beneficial effects that is superior to other interventions at achieving glycemic control, but less marked improvement in physical performance. Exercise combined with cognitive training showed more pronounced improvement in muscle strength, gait speed, and dynamic balance, but ranked behind in decreasing the HbAc1 and FBG.

Conclusions: Personalized health management combined with physical and cognitive training might be the optimal intervention to both accomplish glycemic control and improvement of physical performance. Further RCTs are needed to validate and assess the confidence of our results from this NMA.

Keywords: aging; intervention; network meta-analysis; physical performance; type 2 diabetes mellitus.

Figure 1

Flow diagram

Figure 2

Network geometry for the outcomes of blood glucose level and physical performance. Each intervention node indicates an intervention and is weighted according to the number of participants who received the particular intervention. Each edge (line connecting the nodes) is weighted according to the number of studies and directly compares the treatments it connects. (A) HbAc1. (B) Fasting blood glucose. (C) muscle mass. (D) grip strength. (E) gait speed. (F) lower muscle strength measured by chair stand test. (G) dynamic balance measured by five-time up and go test. PHYS+PSYCH, Physical activity + Psycho-social or cognitive training; PLAC/STD, Placebo or standard care; PHYS+NUTR, Physical activity +nutrition supplementation; PHYS, Physical activity only; Mixed_PHYS, Mixed Physical activity; Health_MA, Health management; PHYS+PHARM, Physical activity + Pharmacotherapy; PHARM, Pharmacotherapy; NUTR, Nutrition supplementation only.