Effects of pharmacological treatment and lifestyle modification on prediabetes: a systematic review and meta-analysis...

Prediabetes is a risk factor for diabetes mellitus; it provides options for disease prevention. Consequently, it is crucial to determine efficient preventive techniques and delineate the trajectory of forthcoming research. A systematic search of PubMed, Embase, and the Cochrane Library was conducted for randomized controlled trials reporting on the effect of pharmacological treatments added to lifestyle modifications in a prediabetic population. Trials were eligible if they reported any of the following outcomes: incidence of diabetes, incidence of normoglycemia, weight change, waist circumference, or FPG. The meta-analysis demonstrated that pharmaceutical intervention alongside lifestyle adjustments markedly decreased diabetes incidence (RR 0.66, 95% CI 0.52-0.83, P < 0.001) and enhanced the incidence of normoglycemia (RR 1.43, 95% CI 1.20-1.71, P < 0.001). Weight loss varied from 1.7 to 5.2 kg, waist circumference reduction ranged from 2.1 to 6.4 cm, and fasting plasma glucose fell by 0.32 to 0.61 mmol/L. Meta-regression revealed that area (P = 0.021) and disease type (P = 0.035) were significant contributors to heterogeneity. Sensitivity analyses validated the reliability of the results. Publication bias was identified for diabetes incidence (Egger's test, P = 0.018), but not for other outcomes. This meta-analysis suggests that pharmacological treatment combined with lifestyle modification is associated with a reduced incidence of diabetes and an increased likelihood of achieving normoglycemia among individuals with prediabetes. Although the primary outcomes were consistent, substantial heterogeneity and variability were observed in secondary metabolic outcomes, indicating that the magnitude of benefit may differ across populations and intervention types. Further high-quality studies are warranted to refine optimal intervention strategies.