Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in US Settings: A Systematic Review and Meta-analysisReportar como inadecuado

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Journal Title:

PLoS Medicine


Volume 13, Number 7


Public Library of Science | 2016-07-26, Pages e1002095-e1002095

Type of Work:

Article | Final Publisher PDF

Abstract: Background: The Diabetes Prevention Program DPP study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States. Methods and Findings: In this systematic review and meta-analysis, we pooled data from studies in the United States implementing DPP lifestyle modification programs focused on modest 5%–7% weight loss through ≥150 min of moderate physical activity per week and restriction of fat intake in clinical, community, and online settings. We reported aggregated pre- and post-intervention weight and cardiometabolic risk factor changes fasting blood glucose FBG, glycosylated hemoglobin HbA1c, systolic or diastolic blood pressure SBP-DBP, total TC or HDL-cholesterol. We searched the MEDLINE, EMBASE, Cochrane Library, and databases from January 1, 2003, to May 1, 2016. Two reviewers independently evaluated article eligibility and extracted data on study designs, populations enrolled, intervention program characteristics duration, number of core and maintenance sessions, and outcomes. We used a random effects model to calculate summary estimates for each outcome and associated 95% confidence intervals CI. To examine sources of heterogeneity, results were stratified according to the presence of maintenance sessions, risk level of participants prediabetes or other, and intervention delivery personnel lay or professional. Forty-four studies that enrolled 8,995 participants met eligibility criteria. Participants had an average age of 50.8 years and body mass index BMI of 34.8 kg-m2, and 25.2% were male. On average, study follow-up was 9.3 mo median 12.0 with a range of 1.5 to 36 months; programs offered a mean of 12.6 sessions, with mean participant attendance of 11.0 core sessions. Sixty percent of programs offered some form of post-core maintenance either email or in person. Mean absolute changes observed were: weight -3.77 kg 95% CI: -4.55; -2.99, HbA1c -0.21% -0.29; -0.13, FBG -2.40 mg-dL -3.59; -1.21, SBP -4.29 mmHg -5.73 -2.84, DBP -2.56 mmHg -3.40, 1.71, HDL +0.85 mg-dL -0.10, 1.60, and TC -5.34 mg-dL -9.72 -0.97. Programs with a maintenance component achieved greater reductions in weight additional -1.66kg and FBG additional -3.14 mg-dl. Findings are subject to incomplete reporting and heterogeneity of studies included, and confounding because most included studies used pre-post study designs. Conclusions: DPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective.

Subject: Health Sciences, Public Health -

Autor: Uma Mudaliar, Azadeh Zabetian, Michael Goodman, Justin B. Echouffo-Tcheugui, Ann L. Albright, Edward W. Gregg, Mohammed Ali,



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