Non-pharmacological interventions for the prevention of type 2 diabetes in low-income and middle-income countries: a systematic review of randomised controlled trials

Abstract

ObjectiveDiabetes poses serious health threats and economic burdens to patients, especially in low-income and middle-income countries (LMICs). This systematic review searches for non-pharmacological interventions for the prevention of type-2 diabetes mellitus (T2DM) among patients who are non-diabetic and pre-diabetic from LMICs.SettingsLMICs.ParticipantsAdult population aged over 18 years without having diabetes.Primary and secondary outcomesPrimary outcome is to measure the change in the incidence of T2DM. The secondary outcome is to measure changes in glycated haemoglobin (HbA1c) level, weight/body mass index (BMI), fasting glucose level and 2-hour glucose from baseline of the included randomised controlled trials.MethodsThis review has been conducted following the standard systematic review guidelines. A total of six electronic databases including MEDLINE, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov and International Clinical Trials Registry Platform were searched in February 2021 using a comprehensive search strategy.Two sets of independent reviewers performed screening, risk of bias (ROB) assessment using the Cochrane ROB tool and data extraction. Narrative coalescence of selected articles was demonstrated using tables. No meta-analysis was performed due to the lack of homogenous intervention strategies and study settings.ResultA total of five studies were included for the review with a combined population of 1734 from three countries. Three of the studies showed a significant reduction in T2DM incidence after the intervention of physical training and dietary modifications. Four of the studies also demonstrated a significant reduction of different secondary outcomes like weight, BMI, fasting and 2-hour plasma glucose and HbA1c. All the studies demonstrated a low ROB in most of the bias assessment domains with some unclear results in allocation concealments.ConclusionsEmphasising non-pharmacological interventions for T2DM prevention can improve health outcomes and lessen the economic burdens, which will be of paramount importance in LMICs.Systematic review registration numberCRD42020191507

The effectiveness of lifestyle interventions on type 2 diabetes and gestational diabetes incidence and cardiometabolic outcomes: A systematic review and meta-analysis of evidence from low- and middle-income countries

“…A recent systematic review described positive health effects related to T2D of five non-pharmacological interventions evaluated through RCTs conducted in LMICs, however, was unable to provide pooled estimates due to few eligible studies. 71 In 2019, Shirinzadeh and co-workers conducted a systematic review and meta-analysis of six RCTs evaluating community-based interventions addressing diet, physical activity, or health behaviour in LMICs showing a reduction in the incidence of diabetes (RR: 0·57 [0·30 to 1·06]) after pooling only three study-specific estimates. 14 Evidence synthesis of lifestyle interventions/T2D prevention programmes in at-risk populations conducted in HICs is in line with our findings.…”