Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in US Settings: A Systematic Review and Meta-analysis

Abstract

BackgroundThe Diabetes Prevention Program (DPP) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States.Methods and FindingsIn this systematic review and meta-analysis, we pooled data from studies in the United States implementing DPP lifestyle modification programs (focused on modest [5%–7%] weight loss through ≥150 min of moderate physical activity per week and restriction of fat intake) in clinical, community, and online settings. We reported aggregated pre- and post-intervention weight and cardiometabolic risk factor changes (fasting blood glucose [FBG], glycosylated hemoglobin [HbA1c], systolic or diastolic blood pressure [SBP/DBP], total [TC] or HDL-cholesterol). We searched the MEDLINE, EMBASE, Cochrane Library, and Clinicaltrials.gov databases from January 1, 2003, to May 1, 2016. Two reviewers independently evaluated article eligibility and extracted data on study designs, populations enrolled, intervention program characteristics (duration, number of core and maintenance sessions), and outcomes. We used a random effects model to calculate summary estimates for each outcome and associated 95% confidence intervals (CI). To examine sources of heterogeneity, results were stratified according to the presence of maintenance sessions, risk level of participants (prediabetes or other), and intervention delivery personnel (lay or professional).Forty-four studies that enrolled 8,995 participants met eligibility criteria. Participants had an average age of 50.8 years and body mass index (BMI) of 34.8 kg/m2, and 25.2% were male. On average, study follow-up was 9.3 mo (median 12.0) with a range of 1.5 to 36 months; programs offered a mean of 12.6 sessions, with mean participant attendance of 11.0 core sessions. Sixty percent of programs offered some form of post-core maintenance (either email or in person). Mean absolute changes observed were: weight -3.77 kg (95% CI: -4.55; -2.99), HbA1c -0.21% (-0.29; -0.13), FBG -2.40 mg/dL (-3.59; -1.21), SBP -4.29 mmHg (-5.73, -2.84), DBP -2.56 mmHg (-3.40, 1.71), HDL +0.85 mg/dL (-0.10, 1.60), and TC -5.34 mg/dL (-9.72, -0.97). Programs with a maintenance component achieved greater reductions in weight (additional -1.66kg) and FBG (additional -3.14 mg/dl).Findings are subject to incomplete reporting and heterogeneity of studies included, and confounding because most included studies used pre-post study designs.ConclusionsDPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective.

Effects of a Weight Loss Program on Metabolic Syndrome, Eating Disorders and Psychological Outcomes: Mediation by Endocannabinoids

“…This weight loss, corresponding to 8.2% of baseline weight, resulted in significant improvement of cardiometabolic and psychological parameters, ED, and QoL (tables 1, 2, 3). These results confirm previous observations reporting clinically meaningful health improvements after a moderate weight loss [29,30,31]. …”

“…This relatively modest weight reduction was associated with favorable changes in blood pressure, plasma cholesterol, and glucose [29]. The analyzed studies retained the DPP's core principles of calorie-restricted diets and 150 min of moderate-intensity exercise per week, and mainly group sessions were administrated.…”

“…Long-term follow-up studies on lifestyle interventions in obesity are rare. As mentioned in a recent meta-analysis, the mean duration of follow-up among 44 studies was 9.3 months [29]. …”

Assessment of Dietary and Life-Style Behaviors of Diabetic and Non-Diabetic Jordanian Atorvastatin Users

“…Therefore, life-style intervention programs should be intensive and have frequent follow-up to achieve significant weight reductions and improve clinical parameters such as lipid profile [24].Many studies found strong and consistent evidence that modest persistent weight loss can delay the progression from pre diabetes to type 2 diabetes [25,26] and is beneficial to the management of type 2 diabetes. Modest weight loss (reduction of 5% of initial body weight), has been shown to improve glycemic control and to reduce the need for glucose-lowering medications [27,28].…”

Cost effectiveness and return on investment of a scalable community weight loss intervention

“…27–29 By using the state-transition Markov model, we assumed that a participant is always in one of a finite number of discrete health states (Markov states). 24 Accordingly, the model was designed to simulate the progression of a hypothetical closed cohort (men started at age 53 years and women at age 54 years, respectively, which were the average ages for WAW participants by sex) in terms of the reduced risk of developing a specific disease as members lost weight and proliferated corresponding health outcomes.…”