Interventions for Reversing Prediabetes: A Systematic Review and Meta-Analysis

• Published in: American journal of preventive medicine Vol. 62; no. 4; pp. 614 - 625
• Main Authors: Galaviz, Karla I., Weber, Mary Beth, Suvada, Kara, Gujral, Unjali P., Wei, Jingkai, Merchant, Rozina, Dharanendra, Sahrudh, Haw, J. Sonya, Narayan, K.M. Venkat, Ali, Mohammed K.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2022; Elsevier Science Ltd
• Subjects: Adult; Diet; Dietary supplements; Disease prevention; Drug therapy; Exercise; Female; Glucose; Health behavior; Humans; Insulin; Intervention; Life Style; Lifestyles; Male; Meta-analysis; Middle Aged; Network Meta-Analysis; Number needed to treat; Prediabetic State - therapy; Systematic review; Traditional Chinese medicine
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2021.10.020

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. 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. 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. 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.