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Diabetes Management: Intensive Lifestyle Interventions for Patients with Type 2 Diabetes

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What the CPSTF Found

About The Systematic Review

The Community Preventive Services Task Force (CPSTF) uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to diabetes management

Huang XL, Pan JH, Chen D, Chen J, Hu TT. Efficacy of lifestyle interventions in patients with type 2 diabetes: A systematic review and meta-analysis. European Journal of Internal Medicine 2016;27;37-47.

The systematic review and meta-analysis included 17 studies (Huang et al., 2016; search period through July 15, 2014). The CPSTF finding is based on results from a subset of 7 studies that evaluated intensive physical activity programs (5 studies) and intensive dietary programs (3 studies) in addition to expert input from team members and the CPSTF. The largest and longest study (Look AHEAD trial) evaluated both intensive dietary and physical activity programs.

Context

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Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 793 kB].

The systematic review included 7 studies. The largest and longest study (Look AHEAD trial) evaluated both intensive dietary and physical activity programs.

  • Dietary Programs (3 studies)
    • Intensive dietary programs led to favorable changes in reported outcomes.
      • Body Mass Index: non-significant decrease
      • Blood glucose (A1c): significant decrease
      • Systolic blood pressure: significant decrease
      • Diastolic blood pressure: significant decrease
      • LDL cholesterol: non-significant decrease
      • HDL cholesterol: significant increase
  • Physical Activity Programs (5 studies)
    • Intensive physical activity programs led to favorable changes in reported outcomes.
      • Body Mass Index: non-significant decrease
      • Blood glucose (A1c): significant decrease
      • Systolic blood pressure: non-significant decrease
      • Diastolic blood pressure: significant decrease
      • LDL cholesterol: non-significant decrease
      • HDL cholesterol: non-significant increase

Summary of Economic Evidence

Huang et al. did not consider evidence or information on the economic benefits of these interventions. An economic evaluation of the Look AHEAD trial reported lower health-care costs over 10 years.

Applicability

Based on evidence from the review, the CPSTF finding is applicable to interventions offered to adults with type 2 diabetes through healthcare settings in the United States.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • How does effectiveness vary between specific programs in different populations (e.g., by race, SES, educational attainment, age, cognitive or physical disabilities)?
  • How effective are programs delivered through the internet, email, apps, or social networking?
  • What is the relative effectiveness of individual and group sessions?
  • What structures and systems are needed to maintain program effectiveness and help participants continue their improvements to diet and physical activity following program completion?
  • What are long-term effects on participants’ glycemic control, weight loss, cardiovascular disease risk factors, morbidity, and mortality?
  • What are program attrition rates? Why do participants drop out, and how can they be retained?
  • Are these interventions effective with children and adolescents?

Study Characteristics

  • All included studies were randomized controlled trials.
  • Evaluated interventions provided a median of 11 sessions that were individual (3 studies) or a combination of individual and group sessions (4 studies).
  • Studies evaluated interventions that provided patients specific, tailored instruction on lifestyle changes through multiple interactions over extended periods of time.
  • Four of the programs provided additional, extended telephone contact and 2 of the programs had frequent, ongoing contact with patients through regular exercise sessions.
  • The median intervention duration was 12 months. All 7 studies established clear goals for patients’ dietary changes (3 studies), physical activity levels (5 studies), or weight loss (2 studies).