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Montes YD, Vergara TA, Molina RT, Guerrero GM, Arrieta LAA, Aschner P, Acosta-Reyes J, Florez-Garcia V, Lechuga EN, Barengo NC. The association between sociodemographic characteristics, clinical indicators and body mass index in a population at risk of type 2 diabetes: A cross-sectional study in two Colombian cities. Prim Care Diabetes 2024; 18:458-465. [PMID: 38862312 DOI: 10.1016/j.pcd.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 05/25/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
AIMS To assess the association between sociodemographic and clinical factors with body mass index (BMI) in a population at risk of type 2 diabetes (T2D) in Bogotá and Barranquilla, Colombia. METHODS This cross-sectional study used data from the PREDICOL Study. Participants with a FINDRISC ≥ 12 who underwent an Oral Glucose Tolerance Test (OGTT) were included in the study (n=1166). The final analytical sample size was 1101 participants. Those with missing data were excluded from the analysis (n=65). The main outcome was body mass index (BMI), which was categorized as normal, overweight, and obese. We utilized unadjusted and adjusted ordinal logistic regression analysis to calculate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS The prevalence of overweight and obesity was 41 % (n=449) and 47 % (n=517), respectively. Participants with a 2-hour glucose ≥139 mg/dl had 1.71 times higher odds of being overweight or obese (regarding normal weight) than participants with normal 2-hour glucose values. In addition, being a woman, waist circumference altered, and blood pressure >120/80 mmHg were statistically significantly associated with a higher BMI. CONCLUSION Strategies to control glycemia, blood pressure, and central adiposity are needed in people at risk of T2D. Future studies should be considered with a territorial and gender focus, considering behavioral, and sociocultural patterns.
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Affiliation(s)
- Yenifer Diaz Montes
- Department of Preventive Medicine and Public Health. School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia; Faculty of Nursing Sciences, Universidad Cooperativa de Colombia, Santa Marta, Colombia.
| | - Tania Acosta Vergara
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia
| | - Rafael Tuesca Molina
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia; ScienceFlows Research Group, Universidad de Valencia, Valencia, Spain
| | - Gillian Martinez Guerrero
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia
| | - Luis A Anillo Arrieta
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia; College of Basic Sciences, Department of Mathematics and Statistics, Universidad del Norte, Barranquilla, Colombia
| | - Pablo Aschner
- Colombian Association for Diabetes, Bogotá, Colombia; Universidad Javeriana, Bogotá, Colombia; San Ignacio University Hospital, Bogotá, Colombia
| | - Jorge Acosta-Reyes
- Department of Preventive Medicine and Public Health. School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia
| | - Victor Florez-Garcia
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia; Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Edgar Navarro Lechuga
- Department of Public Health, Division of Health Sciences, Universidad del Norte, Km 5 vía Puerto Colombia, Barranquilla, Colombia
| | - Noël C Barengo
- Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
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Viswanathan V, Murugan P, Kumpatla S, Parveen R, Devarajan A. Prevention of diabetes from prediabetes in real world setting in South India. Diabetes Metab Syndr 2024; 18:103041. [PMID: 38795632 DOI: 10.1016/j.dsx.2024.103041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/28/2024]
Abstract
AIM The aim was to explore the effect of lifestyle modification in a real world situation to prevent the progression to diabetes in India. METHODS Participants who underwent OGTT from August 2017-2022 and were diagnosed as having Prediabetes (n = 200) were assigned into control (group1, n = 100) received standard care and intervention (group2, n = 100) received intensive counseling on physical activity (PA) and diet. PA included walking for 150 min/week and personalized advice based on the profession. OGTTs were repeated once every 6 months for 5 years and primary outcome was development of DM. RESULTS The conversion rate was significantly higher in the control group than the intervention group (44.6 vs.7.9 %, p < 0.0001). Individuals who reverted back to normal was significantly higher in Group2 compared to Group1 (34.9 vs.6.2 %; p < 0.001). A significant increase in weight, BMI and waist circumference in group1 and significant reduction in glucose and HbA1c was noted in group2. Mean (95%CI) survival time for Group1 was 25.4 (20.8-29.9) and Group2 was 36.4months (32.6-40.1; p < 0.001). The factors which influenced the conversion of prediabetes to DM were averaged BMI, fasting and 2hr glucose levels of all follow up visit measurements. CONCLUSION We can prevent diabetes in individuals with prediabetes using real world strategies in India.
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Affiliation(s)
- Vijay Viswanathan
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (IDF Centre for Excellence in Diabetes Care), Royapuram, Chennai, Tamil Nadu, India.
| | - Premalatha Murugan
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (IDF Centre for Excellence in Diabetes Care), Royapuram, Chennai, Tamil Nadu, India.
| | - Satyavani Kumpatla
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (IDF Centre for Excellence in Diabetes Care), Royapuram, Chennai, Tamil Nadu, India.
| | - Rizwana Parveen
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (IDF Centre for Excellence in Diabetes Care), Royapuram, Chennai, Tamil Nadu, India
| | - Arutselvi Devarajan
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (IDF Centre for Excellence in Diabetes Care), Royapuram, Chennai, Tamil Nadu, India.
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Tarigan M, Setiawan, Tarigan R, Imelda F, Jongudomkarn D. Identifying diabetes risks among Indonesians: A cross-sectional study in a community setting. BELITUNG NURSING JOURNAL 2024; 10:41-47. [PMID: 38425682 PMCID: PMC10900062 DOI: 10.33546/bnj.3112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background There is an upward surge in diabetes patients worldwide, including in Indonesia, annually. Diabetes can lead to new diseases that burden patients' lives further. Nurses can reduce this problem by identifying people at risk of developing diabetes and educating them on how to prevent diabetes. Objective The study aimed to determine the risk of diabetes in the Indonesian population. Methods The descriptive research involved a sample of 1216 Indonesians living in North Sumatra Province. Participants were nondiabetic individuals selected using the convenience method from May to October 2020. This study utilized the Indonesian version of the Finnish Diabetes Risk Score (FINDRISC) tool and employed various statistical analyses, including frequencies, percentages, chi-square test, and Fisher's exact test. Results Of the total samples, 372 were males (30.6%), and 844 were females (69.4%). The risk of developing diabetes was classified as low (57.1%), slightly elevated (36.4%), moderate (5.3%), high (1.0%), and very high (0.2%). Only one of the eight risk factors that differed significantly between men and women was a history of elevated blood glucose levels, with a p-value of 0.02. Conclusion The study identified a portrait of the number and percentage of diabetes risk factors in a community setting in Indonesia. Nurses must provide education on diabetes prevention to not only members of the local community at the research site but also the general public, nationally and globally.
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Affiliation(s)
- Mula Tarigan
- Faculty of Nursing, Universitas Sumatera Utara, Indonesia
| | - Setiawan
- Faculty of Nursing, Universitas Sumatera Utara, Indonesia
| | - Rosina Tarigan
- Faculty of Nursing, Universitas Sumatera Utara, Indonesia
| | - Fatwa Imelda
- Faculty of Nursing, Universitas Sumatera Utara, Indonesia
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Dudzik JM, Senkus KE, Evert AB, Raynor HA, Rozga M, Handu D, Moloney LM. The effectiveness of medical nutrition therapy provided by a dietitian in adults with prediabetes: a systematic review and meta-analysis. Am J Clin Nutr 2023; 118:892-910. [PMID: 37689140 DOI: 10.1016/j.ajcnut.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND A total of 374 million adults worldwide are living with prediabetes, 70% of whom will develop type 2 diabetes mellitus (T2DM) in their lifetime. Medical nutrition therapy (MNT) provided by a dietitian, such as that found in lifestyle interventions, has the potential to improve glycemic control and prevent progression to T2DM. OBJECTIVES The objective of this systematic review was to examine the effectiveness of MNT provided by a dietitian, compared with standard care, on glycemic, cardiometabolic, and anthropometric outcomes in adults with prediabetes. METHODS Searches were conducted for randomized controlled trials (RCTs) published between 1995 and 2022 using electronic databases MEDLINE, CINHAL, and Cochrane Central. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for RCTs. Meta-analyses were conducted using a random-effects model. The certainty of evidence was assessed for each outcome using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method, and a summary of findings table was created using the GRADEpro Guideline Development Tool. RESULTS Thirteen RCTs were included in the analysis, showcasing a variety of MNT interventions delivered by dietitians. Intervention durations ranged from 3 to 24 mo. Compared with standard care, MNT improved hemoglobin A1c (HbA1c) (mean difference [95% confidence interval]: -0.30% [-0.49, -0.12]) and fasting blood glucose (FBG) (-4.97 mg/dL [-6.24, -3.71]). Statistically significant improvements were found in anthropometrics (weight, body mass index, and waist circumference), cholesterol (total, high-, and low-density lipoproteins), and blood pressure (systolic and diastolic). No significant effect was found on T2DM or triglycerides. The certainty of evidence was moderate for FBG and low for HbA1c and incidence of T2DM. CONCLUSIONS In adults with prediabetes, MNT was effective in improving glycemic outcomes, anthropometrics, blood pressure, and most lipid levels. However, most studies had a risk of bias because of the randomization process or deviations from intended interventions. MNT plays a key role in improving cardiometabolic risk factors in adults with prediabetes. TRIAL REGISTRATION NUMBER This study was registered with the registration ID #351421, available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351421.
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Affiliation(s)
- Josephine M Dudzik
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, United States
| | - Katelyn E Senkus
- Department of Human Nutrition and Hospitality Management, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, United States
| | - Alison B Evert
- University of Washington Medicine Primary Care, UW Neighborhood Clinics, Seattle, WA, United States
| | - Hollie A Raynor
- Department of Nutrition, College of Education, Health and Human Sciences, University of Tennessee Knoxville, Knoxville, TN, United States
| | - Mary Rozga
- Academy of Nutrition and Dietetics, Evidence Analysis Library, Chicago, IL, United States
| | - Deepa Handu
- Academy of Nutrition and Dietetics, Evidence Analysis Library, Chicago, IL, United States
| | - Lisa M Moloney
- Academy of Nutrition and Dietetics, Evidence Analysis Library, Chicago, IL, United States.
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Sagastume D, Siero I, Mertens E, Cottam J, Colizzi C, Peñalvo JL. The effectiveness of lifestyle interventions on type 2 diabetes and gestational diabetes incidence and cardiometabolic outcomes: A systematic review and meta-analysis of evidence from low- and middle-income countries. EClinicalMedicine 2022; 53:101650. [PMID: 36119561 PMCID: PMC9475282 DOI: 10.1016/j.eclinm.2022.101650] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND As lifestyle modification offers a unique strategy to prevent diabetes, we evaluated the effectiveness of lifestyle interventions in the prevention of type 2 diabetes and gestational diabetes in low- and middle-income countries (LMICs). METHODS We did a systematic literature review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and Cochrane Library for randomised controlled trials published in English, Spanish, French, and Portuguese between 1 January 2000 and 15 June 2022, evaluating multi-target and multi-component lifestyle interventions in at-risk populations conducted in LMICs. The main outcomes were incidence of type 2 diabetes and gestational diabetes, and indicators of glycaemic control. We assessed the methodological quality of the studies using the Cochrane risk of bias tool. Inverse-variance random-effects meta-analyses estimated the overall effect sizes. Sources of heterogeneity and study bias were evaluated. The study protocol was registered in PROSPERO (CRD42021279174). FINDINGS From 14 330 abstracts, 48 (0·3%) studies with 50 interventions were eligible of which 56% were conducted in lower-middle-income countries, 44% in upper-middle, and none in low-income. 54% of the studies were assessed as moderate risk of bias and 14% as high risk. A median of 246 (IQR 137-511) individuals participated in the interventions with a median duration of 6 (3-12) months. Lifestyle interventions decreased the incidence risk ratio of type 2 diabetes by 25% (0·75 [95% CI 0·61 to 0·91]), and reduced the levels of HbA1c by 0·15% [-0·25 to -0·05], fasting plasma glucose by 3·44 mg/dL [-4·72 to -2·17], and 2-hr glucose tolerance by 4·18 mg/dL [-7·35 to -1·02]. No publication bias was suggested for these outcomes. High levels of heterogeneity (I²≥ 81%) were found in most meta-analyses. Exploration using meta-regressions could not identify any explanatory variable, except for fasting glucose for which the quality score of the articles seems to be an effect modifier decreasing slightly the heterogeneity (72%) in the low risk of bias pooled estimate. The effect on gestational diabetes could not be evaluated due to the scarcity of available studies. INTERPRETATION Comprehensive lifestyle interventions are effective strategies to prevent type 2 diabetes among at-risk populations in LMICs. The heterogeneity identified in our results should be considered when using these interventions to address the onset of type 2 diabetes. FUNDING None.
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Affiliation(s)
- Diana Sagastume
- Corresponding author at: Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.
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Sun C, Lei Y, Lin Z, Li S, Wang M, Gu J. Effects of self-care programs on the incidence of diabetes among adults with prediabetes: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2022; 32:2193-2207. [PMID: 35655374 DOI: 10.1111/jocn.16384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/16/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To verify the effects of self-care programs among adults with prediabetes, to identify the preferable structure components and to summarise the core content components of self-care programs. DESIGN A systematic review and meta-analysis of randomised controlled trials. METHODS PubMed, Embase, Cochrane, CINAHL, PsycINFO, Wanfang, CNKI, Chinese Biomedical Database and Open Grey were searched for studies published from January 2002 to December, 2021. Meta-analysis was conducted to verify the effects of self-care programs on diabetes incidence. Subgroup analyses based on structure components were performed to contrast the effects. We made a critical analysis to generalise the core elements of content components. The study was reported according to PRISMA statement. RESULTS Totally, 15 studies were included in systematic review, of which 14 studies were eligible for meta-analysis. The results of meta-analysis showed the incidence of diabetes for prediabetic adults receiving self-care programs was significantly lower than those who received usual care (OR 0.58; 95% CI 0.46 to 0.73). The results of subgroup analyses based on delivery mode, intervention implementer, health education brochures provided, and follow-up duration showed statistically significant reduction in incidence compared with control group (p < .05). However, the differences of these pair-wise comparisons (face-to-face or remote, individual or interdisciplinary team, with or without brochures provided, ≤1 year or >1 year) were not statistically significant (p > .05). Three core content elements were generalised: cognitive education, behaviour guidance and psychological support. CONCLUSIONS Self-care programs can effectively delay the progression of prediabetes to diabetes. Regardless of the diversified structure components, self-care programs can achieve better effects on the diabetes incidence than usual care, while the optimal structure components still remain unknown. Cognitive education, behaviour guidance and psychological support are core elements for these programs. RELEVANCE TO CLINICAL PRACTICE More clinical trials with rigorous study design are needed to provide further evidence.
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Affiliation(s)
- Caiyun Sun
- School of Nursing, Nanjing Medical University, Nanjing, China.,Nursing department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Lei
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Zheng Lin
- School of Nursing, Nanjing Medical University, Nanjing, China.,Nursing department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sha Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Mi Wang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Junyi Gu
- School of Nursing, Nanjing Medical University, Nanjing, China
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González-Rivas JP, Pavlovska I, Polcrova A, Nieto-Martínez R, Mechanick JI. Transcultural Lifestyle Medicine in Type 2 Diabetes Care: Narrative Review of the Literature. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221095048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Disparities in type 2 diabetes (T2D) care is a global problem across diverse cultures. The Dysglycemia-Based Chronic Disease (DBCD) model promotes early and sustainable interventions along the insulin resistance (stage 1), prediabetes (stage 2), T2D (stage 3), and complications (stage 4) spectrum. In this model, lifestyle medicine is the cornerstone of preventive care to reduce DBCD progression and the socioeconomic/biological burden of disease. A comprehensive literature review, spanning 2000 to 2021, was performed and 55 studies were included examining the effects of lifestyle medicine and their cultural adaptions with different prevention modalities. In stage 1, primordial prevention targets modifiable primary drivers (behavior and environment), unhealthy lifestyles, abnormal adiposity, and insulin resistance with educational and motivational health promotion activities at individual, group, community, and population-based scales. Primary, secondary, and tertiary prevention targets individuals with mild hyperglycemia, severe hyperglycemia, and complications, respectively, using programs that incorporate structured lifestyle interventions. Culturally adapted lifestyle change in primary and secondary prevention improved quality of life and biomarkers, but with a limited impact of tertiary prevention on cardiovascular events. In conclusion, lifestyle medicine with cultural adaptations is an integral part of preventive care in patients with T2D. However, considerable research gaps exist, especially for tertiary prevention.
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Affiliation(s)
- Juan P. González-Rivas
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Iuliia Pavlovska
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anna Polcrova
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Ramfis Nieto-Martínez
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- LifeDoc Health, Memphis, TN, USA
| | - Jeffrey I. Mechanick
- he Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Galaviz KI, Weber MB, Suvada K, Gujral UP, Wei J, Merchant R, Dharanendra S, Haw JS, Narayan KMV, Ali MK. Interventions for Reversing Prediabetes: A Systematic Review and Meta-Analysis. Am J Prev Med 2022; 62:614-625. [PMID: 35151523 PMCID: PMC10420389 DOI: 10.1016/j.amepre.2021.10.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Several interventions have been found to be effective for reversing prediabetes in adults. This systematic review and meta-analysis aims to compare the effectiveness of such interventions. METHODS MEDLINE, Embase, and Cochrane Library databases were searched for articles published between January 1, 2000 and June 27, 2018. RCTs in adults with prediabetes, testing nonsurgical interventions lasting for ≥3 months, and reporting the number of participants achieving normal glucose levels at intervention end were eligible. The pooled risk difference and number needed to treat for achieving normoglycemia were estimated using a random-effects, arm-based network meta-analysis. The strength of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Data were obtained in 2018 and analyzed in 2019 and 2021. RESULTS Of 54 studies included in the systematic review, 47 were meta-analyzed (n=26,460, mean age=53 years, 46% male, 31% White). Studies included 27 arms testing lifestyle modification interventions, 25 testing medications, 5 testing dietary supplements, and 10 testing Chinese medicine. There were 35 control/placebo arms. At a median follow-up of 1.6 years, more participants in the lifestyle modification groups achieved normoglycemia than those in the control (risk difference=0.18, number needed to treat=6). The strength of the evidence was strong for lifestyle modification. Over a median follow-up of 2.7 years, more participants receiving glucagon-like peptide-1 receptor agonists (risk difference=0.47, number needed to treat=2), α-glucosidase inhibitors (risk difference=0.29, number needed to treat=4), and insulin sensitizers (risk difference=0.23, number needed to treat=4) achieved normoglycemia than control. The strength of evidence was moderate for these medications. DISCUSSION Although several pharmacological approaches can reverse prediabetes, lifestyle modification provides the strongest evidence of effectiveness and should remain the recommended approach to address this condition.
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Affiliation(s)
- Karla I Galaviz
- From the Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana.
| | - Mary Beth Weber
- Hubert Department of Global Health (HDGH), Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kara Suvada
- Hubert Department of Global Health (HDGH), Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Unjali P Gujral
- Hubert Department of Global Health (HDGH), Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Rozina Merchant
- Department of Family and Preventime Medicine and the Emory University School of Medicine, Atlanta, Georgia
| | - Sahrudh Dharanendra
- Hubert Department of Global Health (HDGH), Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - J Sonya Haw
- Department of Family and Preventime Medicine and the Emory University School of Medicine, Atlanta, Georgia
| | - K M Venkat Narayan
- Hubert Department of Global Health (HDGH), Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Family and Preventime Medicine and the Emory University School of Medicine, Atlanta, Georgia
| | - Mohammed K Ali
- Hubert Department of Global Health (HDGH), Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Family and Preventime Medicine and the Emory University School of Medicine, Atlanta, Georgia
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González-Rivas JP, Infante-García MM, Nieto-Martinez R, Mechanick JI, Danaei G. Feasibility and Effectiveness of a Preventive Care Program during the Compound Humanitarian Crisis and COVID-19 Pandemic in Venezuela. Nutrients 2022; 14:nu14050939. [PMID: 35267915 PMCID: PMC8912706 DOI: 10.3390/nu14050939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
Effective preventive care programs are urgently needed during humanitarian crises, as has been especially obvious during the COVID-19 pandemic. A pragmatic trial was designed: hybridized intervention (Diabetes Prevention Program [DPP] + medical nutrition therapy + liquid diet [LD]; LD group) vs. DPP only (DPP group). The participants were adults who were overweight/obese and at high risk of type 2 diabetes mellitus (T2DM). The LD consisted of a “homemade” milk- and fruit-juice-based beverage. Pandemic restrictions delayed the program by nine months, tripled the amount of time required for screening, and reduced the total sample to 60%. Eventually, 127 participants were randomized, and 94/127 participants (74.0%) completed the first phase. Participant dropout was influenced by migration, COVID-19 symptoms, education level, and socioeconomic status. In two months, the LD group lost 2.9 kg (p < 0.001) and the DPP group, 2.2 kg (p < 0.001) (between-group p = 0.170), with improvements in their cardiometabolic risk factors. At this stage, the DPP was shown to be feasible and effective, demonstrating weight loss with the improvement of cardiometabolic risk factors in a primary setting in Venezuela, a middle-income country with a chronic humanitarian crisis, during the COVID-19 pandemic.
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Affiliation(s)
- Juan P. González-Rivas
- Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (R.N.-M.); (G.D.)
- International Clinical Research Center (ICRC), St. Anne’s University Hospital (FNUSA) Brno, Pekařská 53, 656 91 Brno, Czech Republic;
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Barquisimeto 3001, Venezuela
- Correspondence: ; Tel.: +420-735190316
| | - María M. Infante-García
- International Clinical Research Center (ICRC), St. Anne’s University Hospital (FNUSA) Brno, Pekařská 53, 656 91 Brno, Czech Republic;
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Barquisimeto 3001, Venezuela
| | - Ramfis Nieto-Martinez
- Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (R.N.-M.); (G.D.)
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Barquisimeto 3001, Venezuela
| | - Jeffrey I. Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY 10028, USA;
- Division of Endocrinology, Diabetes and Bone, Icahn School of Medicine at Mount Sinai, New York, NY 10028, USA
| | - Goodarz Danaei
- Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (R.N.-M.); (G.D.)
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