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Lifestyle changes effective, longer-lasting in reducing diabetes risk compared to medications

Interventions that included healthy lifestyle modifications yielded the same degree of diabetes risk reduction as medications among at risk individuals, according to findings published in JAMA Internal Medicine. While the medication effects were short-lived, lifestyle modifications were sustained for several years before eventually declining over time.

“Diabetes is a burdensome, costly disease affecting 415 million adults globally, with projections of 642 million adults affected by 2040 ... Primary prevention of diabetes has proved to be cost-effective in various populations and settings and is therefore crucial to reducing growing diabetes burdens,” J. Sonya Haw, MD, from the division of endocrinology, metabolism and lipids at Emory University, and colleagues wrote. “Yet, translating these findings into practice remains a major challenge.”

Haw and colleagues performed a meta-analysis of 43 randomized clinical trials including 49,029 participants (mean age, 57.3 years; 48.0% men) to examine the extent to which primary prevention strategies reduce the incidence of diabetes.

Trials that assessed lifestyle modification and medication interventions for prevention of diabetes in at-risk adults aged 18 years or older were included in the analysis, while trials that evaluated alternative therapies and bariatric surgery, as well as those studying patients with gestational diabetes, type 1 or 2 diabetes or metabolic syndrome were excluded. Medications evaluated included those that promoted weight loss or insulin sensitization.

Of the 43 eligible studies, 19 assessed lifestyle modification, 19 assessed medications and five assessed a combination of lifestyle modification and medications.

The researchers found that lifestyle modification reduced the relative risk of diabetes by 39% (RR = 0.61; 95% CI, 0.54-0.68) and medications reduced the RR by 36% (RR = 0.64; 95% CI, 0.54-0.76). Studies involving both lifestyle modification and medications revealed a risk difference of 4.0 (95% CI, 1.8-6.3) cases per 100 person-years (number-needed-to treat, 25).

At the end of follow-up, the RR was reduced by 28% (RR = 0.72; 95% CI, 0.60-0.86) in lifestyle modification studies (mean follow-up, 7.2 years). In studies of medications, however, RR reduction was not sustained after therapy was discontinued (RR = 0.95; 95% CI, 0.79-1.14; mean follow-up, 17 weeks).

“Our study demonstrates that diabetes can be prevented in those at risk through multiple [lifestyle modification] strategies and certain medication classes, allowing health care professionals to individualize preventive care appropriate to community resources, individual motivations, and coverage for various interventions,” Haw and colleagues concluded. “Combined diet and physical activity programs and use of insulin-sensitizing and weight-loss medications achieve the largest diabetes risk reductions.”

They added, “Overall, [lifestyle modification] strategies provide better long-term effects than medications, although strategies to sustain intervention effects are needed. As intervention effects decrease over time, future research should identify cost-effective, successful maintenance strategies to prevent or delay progression to diabetes.” – by Alaina Tedesco

Disclosure: Haw reports no relevant financial disclosures. Please see study for list of all other authors’ relevant financial disclosures.