medwireNews: A meta-analysis shows that although medications and lifestyle changes can both reduce the risk for type 2 diabetes in high-risk patients, only lifestyle modifications have a sustained effect.
“To our knowledge, this is the first meta-analysis to explore the long-term effects of diabetes prevention interventions after treatment withdrawal,” write J Sonya Haw (Emory University, Atlanta, Georgia, USA) and co-researchers in JAMA Internal Medicine.
The analysis includes 43 studies with 49,029 participants, with active intervention periods ranging between 0.5 and 6.0 years. The interventions resulted in an average 39% reduction in diabetes risk in the case of the lifestyle modification studies and a 36% reduction in the case of the medication studies, so that, overall, treating 25 people would prevent one case of diabetes.
However, the team cautions that there was evidence of publication bias, in that “smaller studies with null effects were less likely to be published.”
In the medication studies, weight loss drugs and insulin sensitizers produced the largest risk reductions, of 63% and 53%, respectively.
The researchers say that their study expands on previous ones by including combined phentermine–topiramate, but note that even newer options, such as liraglutide and combined naltrexone–bupropion, may also prove to be effective.
Within the lifestyle modification studies, use of combined diet and exercise interventions produced the best results, achieving a 41% risk reduction. “Since caloric intake and physical activity are independently associated with reduced diabetes risk, combining these may exert an additive effect,” say Haw et al.
Across all the studies, the team found that weight loss was the “key factor” moderating diabetes risk, with each kg of weight lost was associated with a 7% risk reduction.
Five medication studies reported diabetes risk at an average of 17 weeks after the end of the intervention period. These showed that the previous positive effects were not durable, although the team notes that there were no data available for the longer-term effects of weight loss medications.
By contrast, patients in four lifestyle modification trials retained a significant 28% risk reduction, an average of 7.2 years later. This was, however, a smaller risk reduction than that seen at the end of the intervention period, leading the researchers to suggest that “maintenance interventions, even if intermittent, may be needed for prolonged intervention effects.”
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