Zucatti, Kelly P; Teixeira, Paula P; Wayerbacher, Laura F; Piccoli, Giovana F; Correia, Poliana E; Fonseca, Natasha K O; Moresco, Karla S; Guerra, Bruno A; Maduré, Michelle G; Farenzena, Laura P; Frankenberg, Anize D; Brietzke, Elisa; Halpern, Bruno; Franco, Oscar; Colpani, Verônica; Gerchman, Fernando (2022). Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis. Diabetes care, 45(11), pp. 2787-2795. American Diabetes Association 10.2337/dc22-0642
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BACKGROUND
Lifestyle interventions improve the metabolic control of individuals with hyperglycemia.
PURPOSE
We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population.
DATA SOURCES
Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022).
STUDY SELECTION
We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention.
DATA EXTRACTION
Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings.
DATA SYNTHESIS
Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79-1.23) or all-cause (RR 0.93; 95% CI 0.85-1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes.
LIMITATIONS
Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results.
CONCLUSIONS
Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM) |
UniBE Contributor: |
Franco Duran, Oscar Horacio |
Subjects: |
600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services |
ISSN: |
0149-5992 |
Publisher: |
American Diabetes Association |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
02 Nov 2022 09:36 |
Last Modified: |
05 Dec 2022 16:27 |
Publisher DOI: |
10.2337/dc22-0642 |
PubMed ID: |
36318674 |
BORIS DOI: |
10.48350/174412 |
URI: |
https://boris.unibe.ch/id/eprint/174412 |
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