Sydney School of Public Health, The University of Sydney, Sydney, Australia.
BMC Public Health. 2010 Oct 29;10:653. doi: 10.1186/1471-2458-10-653.
The clinical effectiveness of intensive lifestyle interventions in preventing or delaying diabetes in people at high risk has been established from randomised trials of structured, intensive interventions conducted in several countries over the past two decades. The challenge is to translate them into routine clinical settings. The objective of this review is to determine whether lifestyle interventions delivered to high-risk adult patients in routine clinical care settings are feasible and effective in achieving reductions in risk factors for diabetes.
MEDLINE (PubMed), EMBASE, CINAHL, The Cochrane Library, Google Scholar, and grey literature were searched for English-language articles published from January 1990 to August 2009. The reference lists of all articles collected were checked to ensure that no relevant suitable studies were missed.
We included RCTs, before/after evaluations, cohort studies with or without a control group and interrupted time series analyses of lifestyle interventions with the stated aim of diabetes risk reduction or diabetes prevention, conducted in routine clinical settings and delivered by healthcare providers such as family physicians, practice nurses, allied health personnel, or other healthcare staff associated with a health service. Outcomes of interest were weight loss, reduction in waist circumference, improvement of impaired fasting glucose or oral glucose tolerance test (OGTT) results, improvements in fat and fibre intakes, increased level of engagement in physical activity and reduction in diabetes incidence.
Twelve from 41 potentially relevant studies were included in the review. Four studies were suitable for meta-analysis. A significant positive effect of the interventions on weight was reported by all study types. The meta-analysis showed that lifestyle interventions achieved weight and waist circumference reductions after one year. However, no clear effects on biochemical or clinical parameters were observed, possibly due to short follow-up periods or lack of power of the studies meta-analysed. Changes in dietary parameters or physical activity were generally not reported. Most studies assessing feasibility were supportive of implementation of lifestyle interventions in routine clinical care.
Lifestyle interventions for patients at high risk of diabetes, delivered by a variety of healthcare providers in routine clinical settings, are feasible but appear to be of limited clinical benefit one year after intervention. Despite convincing evidence from structured intensive trials, this systematic review showed that translation into routine practice has less effect on diabetes risk reduction.
在过去的二十年中，在几个国家进行的针对结构化强化干预的随机试验已经证实了强化生活方式干预在预防或延迟高危人群发生糖尿病方面的临床有效性。挑战在于将其转化为常规临床环境。本研究的目的是确定在常规临床环境中对高危成年患者实施的生活方式干预在降低糖尿病风险因素方面是否可行且有效。
我们检索了 1990 年 1 月至 2009 年 8 月发表的英文文献，包括 MEDLINE（PubMed）、EMBASE、CINAHL、Cochrane 图书馆、Google Scholar 和灰色文献。查阅了所有收集到的文章的参考文献列表，以确保没有遗漏任何相关的合适研究。
我们纳入了 RCTs、前后评估、有或没有对照组的队列研究以及干预时间序列分析，这些研究的目的是降低糖尿病风险或预防糖尿病，均在常规临床环境中进行，并由家庭医生、执业护士、联合卫生人员或与卫生服务相关的其他卫生保健人员等医疗保健提供者实施。感兴趣的结果是体重减轻、腰围缩小、空腹血糖受损或口服葡萄糖耐量试验（OGTT）结果改善、脂肪和纤维摄入增加、体力活动参与度提高以及糖尿病发病率降低。
在 41 篇可能相关的研究中，有 12 篇被纳入综述。有 4 项研究适合进行荟萃分析。所有研究类型均报告了干预措施对体重的显著积极影响。荟萃分析显示，生活方式干预在一年后实现了体重和腰围的减轻。然而，并没有观察到生化或临床参数的明显效果，这可能是由于随访时间短或分析的研究缺乏效力。一般不报告饮食参数或体力活动的变化。大多数评估可行性的研究都支持在常规临床护理中实施生活方式干预。
在常规临床环境中，由各种医疗保健提供者为糖尿病高危患者提供的生活方式干预是可行的，但在干预一年后，其对临床获益的影响似乎有限。尽管来自结构化强化试验的证据令人信服，但本系统评价显示，将其转化为常规实践对降低糖尿病风险的影响较小。
