Elizabeth Sumamo Schellenberg, BSc, MPH; Donna M. Dryden, PhD; Ben Vandermeer, MSc; Christine Ha, BSc; Christina Korownyk, MD, CCFP
Disclaimer: The findings and conclusions in this article are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank the following persons for their contributions: Carol Spooner (screening, data extraction, and research support), Tamara Durec (searching), Andrea Milne (searching), and Teodora Radisic (article retrieval).
Grant Support: By the Agency for Healthcare Research and Quality (contract 290-2007-10021-I).
Potential Conflicts of Interest: Mr. Vandermeer: Grant: Agency for Healthcare Research and Quality. Dr. Korownyk: Grant: Agency for Healthcare Research and Quality. All other authors have no disclosures. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0950.
Requests for Single Reprints: Christina Korownyk, MD, CCFP, Department of Family Medicine, 1706 College Plaza, 8215 112 Street, University of Alberta, Edmonton, Alberta T6G 2C8, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Sumamo Schellenberg: Edmonton Clinic Health Academy, 4-88D, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Dr. Dryden: Edmonton Clinic Health Academy, 4-474, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Mr. Vandermeer: Edmonton Clinic Health Academy, 4-496B, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Ms. Ha: Edmonton Clinic Health Academy, 4th Floor, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
Dr. Korownyk: Department of Family Medicine, 1706 College Plaza, 8215 112 Street, University of Alberta, Edmonton, Alberta T6G 2C8, Canada.
Author Contributions: Conception and design: E. Sumamo Schellenberg, D.M. Dryden, C. Ha, C. Korownyk.
Analysis and interpretation of the data: E. Sumamo Schellenberg, D.M. Dryden, B. Vandermeer, C. Ha, C. Korownyk.
Drafting of the article: E. Sumamo Schellenberg, D.M. Dryden, C. Korownyk.
Critical revision of the article for important intellectual content: E. Sumamo Schellenberg, D.M. Dryden, B. Vandermeer, C. Korownyk.
Final approval of the article: E. Sumamo Schellenberg, D.M. Dryden, B. Vandermeer, C. Ha, C. Korownyk.
Statistical expertise: B. Vandermeer.
Obtaining of funding: D.M. Dryden.
Administrative, technical, or logistic support: E. Sumamo Schellenberg, D.M. Dryden, C. Ha.
Collection and assembly of data: E. Sumamo Schellenberg, D.M. Dryden, C. Ha.
The effect of multifaceted lifestyle interventions on clinically oriented outcomes across a spectrum of metabolic risk factors and abnormal glucose is unclear.
To systematically review the effectiveness of lifestyle interventions on minimizing progression to diabetes in high-risk patients or progression to clinical outcomes (such as cardiovascular disease and death) in patients with type 2 diabetes.
5 electronic databases (1980 to June 2013), reference lists, and gray literature.
Two reviewers independently identified randomized, controlled trials of lifestyle interventions (≥3 months’ duration) that included exercise, diet, and at least 1 other component; the comparator was standard care.
One reviewer extracted and a second verified data. Two reviewers independently assessed methodological quality.
Nine randomized, controlled trials with patients who were at risk for diabetes and 11 with patients who had diabetes were included. Seven studies reported that lifestyle interventions decreased the risk for diabetes from the end of intervention up to 10 years after it. In patients with diabetes, 2 randomized, controlled trials (which included pharmacotherapy) reported no improvement in all-cause mortality (risk ratio, 0.75 [95% CI, 0.53 to 1.06]). Composite outcomes for cardiovascular disease were too heterogeneous to pool. One trial reported improvement in microvascular outcomes at 13-year follow-up.
Most trials focused on surrogate measures (such as weight change, blood pressure, and lipids) for which clinical relevance was unclear.
Comprehensive lifestyle interventions effectively decrease the incidence of type 2 diabetes in high-risk patients. In patients who already have type 2 diabetes, there is no evidence of reduced all-cause mortality and insufficient evidence to suggest benefit on cardiovascular and microvascular outcomes.
Agency for Healthcare Research and Quality.
Appendix Table 1. Search Strategy
Summary of evidence search and selection.
Appendix Table 2. Descriptions of Lifestyle Interventions for Patients at Risk for Diabetes
Appendix Table 3. Descriptions of Lifestyle Interventions for Patients With Type 2 Diabetes
Appendix Table 4. Summary of Results for Patients at Risk for Diabetes
Effect of lifestyle interventions versus usual care on development of diabetes for high-risk patients.
M–H = Mantel–Haenszel.
Appendix Table 5. Summary of Results for Patients With Type 2 Diabetes
Effect of lifestyle interventions versus usual care on all-cause mortality for patients with type 2 diabetes.
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Elizabeth Sumamo Schellenberg, Donna M. Dryden, Ben Vandermeer, Christine Ha, Christina Korownyk. Lifestyle Interventions for Patients With and at Risk for Type 2 Diabetes: A Systematic Review and Meta-analysis. Ann Intern Med. 2013;159: 543–551. doi: 10.7326/0003-4819-159-8-201310150-00007
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Published: Ann Intern Med. 2013;159(8): 543-551.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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