Interventions for Reversing Prediabetes: A Systematic Review and Meta-Analysis

• Authors: Karla Galaviz Arredondo, Emory University; Mary Weber, Emory University; Kara Suvada, Emory University; Unjali Gujral, Emory University; Jingkai Wei, University of South Carolina; Rozina Merchant, Emory University; Sahrudh Dharanendra, Emory University; Jeehea Haw, Emory University; Kabayam Venkat Narayan, Emory University; Mohammed Ali, Emory University
• Journal Title: AMERICAN JOURNAL OF PREVENTIVE MEDICINE
• Volume: Volume 62, Number 4
• Publisher: ELSEVIER SCIENCE INC | 2022-03-16, Pages 614-625
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.amepre.2021.10.020
• Subjects: Health Sciences, Public Health; Health Sciences, Nutrition
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Medicine, General & Internal; General & Internal Medicine; NORMAL GLUCOSE REGULATION; RISK; PREVENTION; REGRESSION; REDUCTION; MEDICINE; DISEASE

Abstract

Introduction: Several interventions have been found to be effective for reversing prediabetes in adults. This systematic review and meta-analysis aims to compare the effectiveness of such interventions. Methods: MEDLINE, Embase, and Cochrane Library databases were searched for articles published between January 1, 2000 and June 27, 2018. RCTs in adults with prediabetes, testing nonsurgical interventions lasting for ≥3 months, and reporting the number of participants achieving normal glucose levels at intervention end were eligible. The pooled risk difference and number needed to treat for achieving normoglycemia were estimated using a random-effects, arm-based network meta-analysis. The strength of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Data were obtained in 2018 and analyzed in 2019 and 2021. Results: Of 54 studies included in the systematic review, 47 were meta-analyzed (n=26,460, mean age=53 years, 46% male, 31% White). Studies included 27 arms testing lifestyle modification interventions, 25 testing medications, 5 testing dietary supplements, and 10 testing Chinese medicine. There were 35 control/placebo arms. At a median follow-up of 1.6 years, more participants in the lifestyle modification groups achieved normoglycemia than those in the control (risk difference=0.18, number needed to treat=6). The strength of the evidence was strong for lifestyle modification. Over a median follow-up of 2.7 years, more participants receiving glucagon-like peptide-1 receptor agonists (risk difference=0.47, number needed to treat=2), α-glucosidase inhibitors (risk difference=0.29, number needed to treat=4), and insulin sensitizers (risk difference=0.23, number needed to treat=4) achieved normoglycemia than control. The strength of evidence was moderate for these medications. Discussion: Although several pharmacological approaches can reverse prediabetes, lifestyle modification provides the strongest evidence of effectiveness and should remain the recommended approach to address this condition.