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Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force.

Abstract

BACKGROUND

Trials have shown efficacy of rigorous diet and physical activity promotion programs to reduce diabetes incidence and improve glycemic measures in adults at increased risk for type 2 diabetes.

PURPOSE

To evaluate diet and physical activity promotion programs for persons at increased risk for type 2 diabetes, primarily to reduce diabetes risk and decrease body weight and glycemia.

DATA SOURCES

MEDLINE, the Cochrane Central Register of Controlled Trials, CAB Abstracts, Global Health, and Ovid HealthSTAR from 1991 through 27 February 2015, with no language restriction.

STUDY SELECTION

8 researchers screened articles for single-group or comparative studies of combined diet and physical activity promotion programs with at least 2 sessions over at least 3 months in participants at increased risk for type 2 diabetes.

DATA EXTRACTION

7 researchers extracted data on study design; participant, intervention, and outcome descriptions; and results and assessed study quality.

DATA SYNTHESIS

53 studies (30 of diet and physical activity promotion programs vs. usual care, 13 of more intensive vs. less intensive programs, and 13 of single programs) evaluated 66 programs. Compared with usual care, diet and physical activity promotion programs reduced type 2 diabetes incidence (risk ratio [RR], 0.59 [95% CI, 0.52 to 0.66]) (16 studies), decreased body weight (net change, -2.2% [CI, -2.9% to -1.4%]) (24 studies) and fasting blood glucose level (net change, -0.12 mmol/L [-2.2 mg/dL] [CI, -0.20 to -0.05 mmol/L {-3.6 to -0.9 mg/dL}]) (17 studies), and improved other cardiometabolic risk factors. Evidence for clinical events was limited. More intensive programs were more effective.

LIMITATIONS

Wide variation in diet and physical activity promotion programs limited identification of features most relevant to effectiveness. Evidence on clinical outcomes and in children was sparse.

CONCLUSION

Combined diet and physical activity promotion programs are effective at decreasing diabetes incidence and improving cardiometabolic risk factors in persons at increased risk. More intensive programs are more effective.

PRIMARY FUNDING SOURCE

Centers for Disease Control and Prevention Community Preventive Services Task Force.

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    Source

    Annals of internal medicine 163:6 2015 Sep 15 pg 437-51

    MeSH

    Blood Glucose
    Blood Pressure
    Diabetes Mellitus, Type 2
    Diet, Reducing
    Exercise
    Health Promotion
    Humans
    Lipids
    Risk Factors
    Weight Loss

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    26167912

    Citation

    Balk, Ethan M., et al. "Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: a Systematic Review for the Community Preventive Services Task Force." Annals of Internal Medicine, vol. 163, no. 6, 2015, pp. 437-51.
    Balk EM, Earley A, Raman G, et al. Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force. Ann Intern Med. 2015;163(6):437-51.
    Balk, E. M., Earley, A., Raman, G., Avendano, E. A., Pittas, A. G., & Remington, P. L. (2015). Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force. Annals of Internal Medicine, 163(6), pp. 437-51. doi:10.7326/M15-0452.
    Balk EM, et al. Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: a Systematic Review for the Community Preventive Services Task Force. Ann Intern Med. 2015 Sep 15;163(6):437-51. PubMed PMID: 26167912.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force. AU - Balk,Ethan M, AU - Earley,Amy, AU - Raman,Gowri, AU - Avendano,Esther A, AU - Pittas,Anastassios G, AU - Remington,Patrick L, PY - 2015/7/14/entrez PY - 2015/7/15/pubmed PY - 2015/12/15/medline SP - 437 EP - 51 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 163 IS - 6 N2 - BACKGROUND: Trials have shown efficacy of rigorous diet and physical activity promotion programs to reduce diabetes incidence and improve glycemic measures in adults at increased risk for type 2 diabetes. PURPOSE: To evaluate diet and physical activity promotion programs for persons at increased risk for type 2 diabetes, primarily to reduce diabetes risk and decrease body weight and glycemia. DATA SOURCES: MEDLINE, the Cochrane Central Register of Controlled Trials, CAB Abstracts, Global Health, and Ovid HealthSTAR from 1991 through 27 February 2015, with no language restriction. STUDY SELECTION: 8 researchers screened articles for single-group or comparative studies of combined diet and physical activity promotion programs with at least 2 sessions over at least 3 months in participants at increased risk for type 2 diabetes. DATA EXTRACTION: 7 researchers extracted data on study design; participant, intervention, and outcome descriptions; and results and assessed study quality. DATA SYNTHESIS: 53 studies (30 of diet and physical activity promotion programs vs. usual care, 13 of more intensive vs. less intensive programs, and 13 of single programs) evaluated 66 programs. Compared with usual care, diet and physical activity promotion programs reduced type 2 diabetes incidence (risk ratio [RR], 0.59 [95% CI, 0.52 to 0.66]) (16 studies), decreased body weight (net change, -2.2% [CI, -2.9% to -1.4%]) (24 studies) and fasting blood glucose level (net change, -0.12 mmol/L [-2.2 mg/dL] [CI, -0.20 to -0.05 mmol/L {-3.6 to -0.9 mg/dL}]) (17 studies), and improved other cardiometabolic risk factors. Evidence for clinical events was limited. More intensive programs were more effective. LIMITATIONS: Wide variation in diet and physical activity promotion programs limited identification of features most relevant to effectiveness. Evidence on clinical outcomes and in children was sparse. CONCLUSION: Combined diet and physical activity promotion programs are effective at decreasing diabetes incidence and improving cardiometabolic risk factors in persons at increased risk. More intensive programs are more effective. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention Community Preventive Services Task Force. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/26167912/full_citation L2 - https://www.annals.org/article.aspx?doi=10.7326/M15-0452 DB - PRIME DP - Unbound Medicine ER -