Long-term Sustainability of Diabetes Prevention Approaches

作者：JEEHEA SONYA HAW, Karla Ivette Galaviz, Audrey Straus, Alysse J. Kowalski, Matthew James Magee, Mary Beth Weber, Jingkai Wei, K.M. Venkat Narayan, Mohammed K. Ali · 发表于：JAMA Internal Medicine · 年份：2017 · DOI：10.1001/jamainternmed.2017.6040 · 被引用次数：356 · 研究领域：Diabetes, Cardiovascular Risks, and Lipoproteins、Diabetes Management and Education、Diabetes Treatment and Management

Importance: Diabetes prevention is imperative to slow worldwide growth of diabetes-related morbidity and mortality. Yet the long-term efficacy of prevention strategies remains unknown. Objective: To estimate aggregate long-term effects of different diabetes prevention strategies on diabetes incidence. Data Sources: Systematic searches of MEDLINE, EMBASE, Cochrane Library, and Web of Science databases. The initial search was conducted on January 14, 2014, and was updated on February 20, 2015. Search terms included prediabetes, primary prevention, and risk reduction. Study Selection: Eligible randomized clinical trials evaluated lifestyle modification (LSM) and medication interventions (>6 months) for diabetes prevention in adults (age ≥18 years) at risk for diabetes, reporting between-group differences in diabetes incidence, published between January 1, 1990, and January 1, 2015. Studies testing alternative therapies and bariatric surgery, as well as those involving participants with gestational diabetes, type 1 or 2 diabetes, and metabolic syndrome, were excluded. Data Extraction and Synthesis: Reviewers extracted the number of diabetes cases at the end of active intervention in treatment and control groups. Random-effects meta-analyses were used to obtain pooled relative risks (RRs), and reported incidence rates were used to compute pooled risk differences (RDs). Main Outcomes and Measures: The main outcome was aggregate RRs of diabetes in treatment vs control participants. ...