Year: 2019
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Prevention of type 2 diabetes (T2D) is a great challenge worldwide. The aim of this evidence synthesis was to summarize the available evidence in order to update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy. We conducted a systematic review and, where appropriate, meta-analyses of randomized controlled trials (RCTs) carried out in people with impaired glucose tolerance (IGT) (six studies) or dysmetabolism (one study) to answer the following questions: What is the evidence that T2D is preventable by lifestyle changes? What is the optimal diet (with a particular focus on diet quality) for prevention, and does the prevention of T2D result in a lower risk of late complications of T2D? The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess the certainty of the trial evidence. Altogether seven RCTs (N = 4090) fulfilled the eligibility criteria and were included in the meta-analysis. The diagnosis of incident diabetes was based on an oral glucose tolerance test (OGTT). The overall risk reduction of T2D by the lifestyle interventions was 0.53 (95% CI 0.41; 0.67). Most of the trials aimed to reduce weight, increase physical activity, and apply a diet relatively low in saturated fat and high in fiber. The PREDIMED trial that did not meet eligibility criteria for inclusion in the meta-analysis was used in the final assessment of diet quality. We conclude that T2D is preventable by changing lifestyle and the risk reduction is sustained for many years after the active intervention (high certainty of evidence). Healthy dietary changes based on the current recommendations and the Mediterranean dietary pattern can be recommended for the long-term prevention of diabetes. There is limited or insufficient data to show that prevention of T2D by lifestyle changes results in a lower risk of cardiovascular and microvascular complications.
Source: Nutrients
DOI: 10.3390/nu11112611
Institutions: University of Eastern Finland, St. Michael's Hospital, University of Toronto, Physicians Committee for Responsible Medicine, Institute of Clinical and Experimental Medicine, Federico II University Hospital, University of Naples Federico II, Aarhus University Hospital, German Center for Diabetes Research, German Institute of Human Nutrition, Stiftung Charité, Charité - Universitätsmedizin Berlin, National and Kapodistrian University of Athens, Hippocration General Hospital, Instituto de Salud Carlos III, Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition, Institut de Recerca Biomèdica Catalunya Sud, Centro de Investigación Biomédica en Red, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Kuopio University Hospital
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,026
Funders: Danone, Almond Board of California, Dairy Farmers of Canada, Canadian Cardiovascular Society, Diabetes Canada, European Food Safety Authority, Glycemic Index Foundation, Alberta Pulse Growers Commission, Loblaw Companies Limited, Physicians Committee for Responsible Medicine, Physicians' Services Incorporated Foundation, Society for Endocrinology, European Commission, Generalitat de Catalunya, University of Toronto, European Association for the Study of Diabetes, Instituto Danone, International Nut and Dried Fruit Council, International Sweeteners Association, Canadian Institutes of Health Research, Banting and Best Diabetes Centre, University of Toronto, Instituto de Salud Carlos III, Obesity Canada, Ontario Ministry of Research and Innovation
Awards: G4686486482, G6116529611
OpenAlex ID: W2984149348