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Interventions for Reversing Prediabetes: A Systematic Review and Meta-Analysis
Karla I Galaviz1, Mary Beth Weber2, Kara Suvada2
1From the Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana.
American Journal of Preventive Medicine
|February 13, 2022
Summary
Lifestyle modification is the most effective intervention for reversing prediabetes in adults, showing strong evidence. Medications like GLP-1 receptor agonists also show effectiveness, but lifestyle changes remain the recommended approach.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Preventive Medicine
Background:
- Prediabetes affects a significant portion of the adult population, increasing the risk of type 2 diabetes.
- Several interventions exist to reverse prediabetes, but their comparative effectiveness is not well-established.
Purpose of the Study:
- To systematically review and compare the effectiveness of various interventions for reversing prediabetes in adults.
- To determine the most effective strategies for achieving normoglycemia in individuals with prediabetes.
Main Methods:
- A systematic review and network meta-analysis of randomized controlled trials (RCTs) published between 2000 and 2018.
- Included RCTs in adults with prediabetes, testing non-surgical interventions of ≥3 months duration.
- Pooled risk difference and number needed to treat for normoglycemia were estimated; evidence strength was assessed using GRADE.
Main Results:
- 47 studies (n=26,460) were meta-analyzed, including lifestyle modification, medications, dietary supplements, and Chinese medicine interventions.
- Lifestyle modification demonstrated strong evidence, with a risk difference of 0.18 (number needed to treat=6) for achieving normoglycemia.
- Medications like GLP-1 receptor agonists (RD=0.47, NNT=2), alpha-glucosidase inhibitors (RD=0.29, NNT=4), and insulin sensitizers (RD=0.23, NNT=4) showed moderate evidence.
Conclusions:
- Lifestyle modification is the most effective intervention for reversing prediabetes, supported by strong evidence.
- Pharmacological interventions can also reverse prediabetes, but lifestyle changes should remain the primary recommended approach.
- Further research may explore optimal combination therapies for prediabetes reversal.
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