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Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes

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From Māori Health Review Issue 3
Authors:
  • Gillies C et al
Summary:

The authors conducted a systematic review and meta-analysis in order to assess the effectiveness of pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance. The analysis included 21 randomised, controlled trials, reporting data for 8,084 patients. For lifestyle interventions compared to standard advice, the hazard ratio (HR) was 0.51 (95% CI 0.44-0.60), NNTB 6.4 (95% CI 5.0- 8.4). For oral diabetes drugs vs control HR 0.70 (95% CI 0.62-0.79), NNTB 10.8 (95% CI 8.1-15.0). For orlistat vs control HR 0.44 (95% CI 0.28-0.69), NNTB 5.4 (95% CI 4.1-7.6). For the herbal remedy jiangtang bushen vs standard diabetes advice HR 0.32 (95% CI 0.03-3.07), NNTB 4.0 (95% CI NNTH 16.9 to NNTB 24.8). In conclusion the authors note that both lifestyle and pharmacological interventions reduce the rate of progression to type 2 diabetes to a similar degree.

Comment:
The previous study showed that the prevalence of insulin resistance in a Mäori community was high with almost half of all adults aged 30-39 at increased risk for developing type 2 diabetes. The results of this meta analysis of interventions to prevent type 2 diabetes in such a population is therefore timely. My patients with impaired glucose tolerance always ask to hold off the drug treatment if possible. It is therefore reassuring to see that lifestyle interventions, when applied adequately, are as effective as drug treatment. Note that the effectiveness of jiangtang bushen, a herbal recipe, was not significant.
Reference: BMJ. 2007. 10; 334(7588):299
Abstract
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Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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