Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Am J Prev Med. 2023 Nov;65(5):906-915. doi: 10.1016/j.amepre.2023.05.012. Epub 2023 May 20.
Systematic reviews of interventions for diabetes prevention have focused on lifestyle interventions, including the Diabetes Prevention Program (DPP) and translations of the DPP. However, nationally, few people with prediabetes have joined or completed a DPP, with one cited barrier being committing to a yearlong program. This study was a systematic review to evaluate the effectiveness of lower-intensity lifestyle interventions for prediabetes on weight change, glycemia, and health behaviors.
English-language studies from PubMed, Embase, PsycINFO, and CINAHL from 2000 to February 23, 2022 were searched for RCTs of nonpregnant adults with prediabetes and elevated BMI and lower-intensity interventions (defined as ≤12 months and <14 sessions over 6 months). Two reviewers independently identified 11 trials, assessed study quality (using Cochrane risk-of-bias tool), and extracted data serially. A qualitative synthesis was conducted by outcome.
Only 1 of 11 trials of lower-intensity interventions was of high quality (>80% follow-up rate and low risk of bias). This 6-month study compared an app with standardized dietary advice, showing a 3-kg greater body weight reduction and 0.2% greater reduction of HbA1c.
The evidence on lower-intensity lifestyle interventions for diabetes prevention is limited by the small number and methodologic weaknesses of previous trials, and future research is needed in this area. Given the low uptake of and retention in evidence-based high-intensity programs, future work is needed to investigate the effectiveness of novel lower-intensity interventions offered with established DPP content of varying duration and intensity.
针对糖尿病预防的干预措施的系统评价主要集中在生活方式干预上，包括糖尿病预防计划（DPP）及其翻译版本。然而，在全国范围内，很少有糖尿病前期患者加入或完成 DPP，其中一个被引用的障碍是承诺参加为期一年的计划。本研究是一项系统评价，旨在评估针对糖尿病前期的低强度生活方式干预对体重变化、血糖和健康行为的有效性。
从 2000 年至 2022 年 2 月 23 日，在 PubMed、Embase、PsycINFO 和 CINAHL 上搜索了英语语言的随机对照试验，纳入了患有糖尿病前期和升高的 BMI 以及低强度干预（定义为≤12 个月且<14 次/6 个月）的非孕妇成年人。两名评审员独立识别了 11 项试验，使用 Cochrane 偏倚风险工具评估了研究质量，并按顺序提取数据。通过结局进行定性综合分析。
11 项低强度干预试验中只有 1 项为高质量（>80%的随访率和低偏倚风险）。这项为期 6 个月的研究比较了应用程序与标准化饮食建议，显示体重减轻了 3 公斤，HbA1c 降低了 0.2%。
糖尿病预防的低强度生活方式干预的证据受到先前试验数量少和方法学弱点的限制，因此需要在这一领域开展进一步研究。鉴于高证据强度计划的参与度和保留率较低，未来需要研究不同时长和强度的既定 DPP 内容的各种新型低强度干预措施的有效性。
