Intervention Review

Long-term non-pharmacological weight loss interventions for adults with prediabetes

  1. Susan L Norris1,*,
  2. Xuanping Zhang2,
  3. Alison Avenell3,
  4. Edward Gregg2,
  5. Christopher H Schmid4,
  6. Joseph Lau5

Editorial Group: Cochrane Metabolic and Endocrine Disorders Group

Published Online: 20 APR 2005

Assessed as up-to-date: 30 MAY 2004

DOI: 10.1002/14651858.CD005270


How to Cite

Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J. Long-term non-pharmacological weight loss interventions for adults with prediabetes. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD005270. DOI: 10.1002/14651858.CD005270.

Author Information

  1. 1

    Oregon Health Sciences University, Department of Medical Informatics and Clinical Epidemiology, Portland, Oregon, USA

  2. 2

    Center for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, USA

  3. 3

    University of Aberdeen, Health Services Research Unit, Aberdeen, UK

  4. 4

    Tufts University School of Medicine, Boston, Massachusetts, USA

  5. 5

    Tufts Medical Centre, New England Medical Centre/Tufts Evidence-based Practice Center Institute for Clinical Research and Health Policy Studies, Boston, MA, USA

*Susan L Norris, Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Mail Stop B1CC, Portland, Oregon, 97239, USA. norriss@ohsu.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Most persons with prediabetes (impaired glucose tolerance or impaired fasting glucose) are overweight, and obesity worsens the metabolic and physiologic abnormalities associated with this condition. Prediabetes is an important risk factor for the development of type 2 diabetes.

Objectives

The objective of this review was to assess the effectiveness of dietary, physical activity, and behavioral weight loss, and weight control interventions for adults with prediabetes.

Search methods

Studies were obtained from computerized searches of multiple electronic bibliographic dababases, supplemented by hand searches of selected journals, and consultation with experts in obesity research. The last search was conducted May, 2004.

Selection criteria

Studies were included if they were published or unpublished randomized controlled trials in any language and examined weight loss or weight control strategies using one or more dietary, physical activity, or behavioral interventions, with a follow-up interval of at least 12 months.

Data collection and analysis

Effects were combined using a random-effects model.

Main results

Nine studies were identified, with a total of 5,168 participants. Follow-up ranged from 1 to 10 years. Quantitative synthesis was limited by the heterogeneity of populations, settings, and interventions and by the small number of studies that examined outcomes other than weight. Overall, in comparisons with usual care, four studies with a follow-up of one year reduced weight by 2.8 kg (95 % confidence interval (CI) 1.0 to 4.7) (3.3% of baseline body weight) and decreased body mass index by 1.3 kg/m2 (95% CI 0.8 to 1.9). Weight loss at two years was 2.6 kg (95% CI 1.9 to 3.3) (three studies). Modest improvements were noted in the few studies that examined glycemic control, blood pressure, or lipid concentrations (P > 0.05). No data on quality of life or mortality were found. The incidence of diabetes was significantly lower in the intervention groups versus the controls in three of five studies examining this outcome at 3 to 6 years follow-up.

Authors' conclusions

Overall, weight loss strategies using dietary, physical activity, or behavioral interventions produced significant improvements in weight among persons with prediabetes and a significant decrease in diabetes incidence. Further work is needed on the long-term effects of these interventions on morbidity and mortality and on how to implement these interventions in diverse community settings.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Long-term non-pharmacological weight loss interventions for adults with prediabetes

Persons with blood glucose levels that are abnormal, but not in the range of persons with diabetes, are said to have prediabetes, which often precedes the development of type 2 diabetes. Most persons with prediabetes are overweight and obesity worsens the blood glucose and other problems associated with prediabetes. In this review we found that dietary, physical activity, or behavioral interventions produced significant improvements in weight among persons with prediabetes and a significant decrease in diabetes incidence. Modest, but not statistically significant improvements were noted in the few studies that examined blood sugar control, blood pressure, and lipid levels. No data on quality of life or mortality were found.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

糖尿病前期的成年人之長期非藥物減重介入措施

大多數罹患糖尿病前期(葡萄糖失耐或空腹血糖異常)的人都是體重過重,肥胖會導致代謝與生理異常更加惡化。糖尿病前期是進展為糖尿病的一個重要危險因子。

目標

本篇評論的目的是評估糖尿病前期的飲食、身體活動和行為減重與體重控制介入措施的效益。

搜尋策略

從電腦搜查多個電子書目數據庫,輔以手工進行檢索選定期刊,並且諮詢肥胖研究專家。最後一次進行檢索的日期是2004年5月。

選擇標準

無論是已經發表或尚未發表的任何語言的隨機對照試驗,只要是檢測使用一個或多個飲食、身體活動、或行為介入來達到減重或體重控制的策略,並且繼續追蹤至少12個月以上的研究都被納入。

資料收集與分析

使用隨機效益模型(random effects model)來合計效益。

主要結論

確認有9個研究,總共有5168參加者,追蹤1至10年。由於人口、試驗環境、和介入措施的異質性、和少數檢測結果為體重以外的研究,因此定量分析受到限制。總體而言,和一般照顧(usual care)相比,4個追蹤1年的研究,體重可以減輕2.8公斤(95% confidence interval (CI) 1.0 to4.7) (介入前基準體重的3.3%),並且身體質量指數下降了1.3 kg/m2 (95% CI 0.8 to 1.9)。追蹤2年則體重減輕2.6公斤(95% CI 1.9 to 3.3)(3個研究)。一些檢測血糖、血壓或血脂濃度的研究顯示改善效果不大(P > 0.05)。在生活品質和死亡率則沒有數據報告。有3到5個追蹤3至6年的研究顯示:糖尿病的發病率在介入組明顯低於對照組。

作者結論

總的來說,糖尿病前期的人使用飲食、身體活動或行為介入的減重策略可以顯著改善體重,並且顯著降低糖尿病發病率。未來工作仍需要放在這些介入措施對發病率和死亡率的長期影響,以及如何落實這些措施在不同的社區環境。

翻譯人

本摘要由慈濟醫院傅振宗翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

糖尿病前期的人使用飲食、身體活動或行為介入可以減輕體重和降低糖尿病發病率。血糖不正常但不屬於糖尿病患的稱為糖尿病前期,這往往預示會進展為糖尿病。大多數糖尿病前期的人都是過重,而肥胖會導致血糖與糖尿病前期的其他相關問題惡化。在這次評論,我們發現,使用飲食、身體活動或行為介入可以明顯改善糖尿病前期者的體重,並且有意義降低糖尿病發病率。一些檢測血糖、血壓或血脂的研究顯示有些許改善,但是並沒有統計意義。在生活品質和死亡率沒有數據報告。