Original Article

Acta Diabetologica

, Volume 51, Issue 5, pp 853-863

First online:

Prevention of type 2 diabetes in obese at-risk subjects: a systematic review and meta-analysis

  • Claudia MerlottiAffiliated withCattedra di Medicina Interna and Cattedra di Statistica Medica e Biometria, Dipartimento di Scienze della Salute, Università degli Studi di Milano
  • , Alberto MorabitoAffiliated withDipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano
  • , Valerio CerianiAffiliated withIRCCS Multimedica
  • , Antonio E. PontiroliAffiliated withCattedra di Medicina Interna and Cattedra di Statistica Medica e Biometria, Dipartimento di Scienze della Salute, Università degli Studi di Milano Email author 

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Abstract

Different intervention strategies can prevent new cases of type 2 diabetes (T2DM) in obese subjects. The present systematic review and meta-analysis evaluates the effectiveness of different strategies in prevention of type 2 diabetes in obese subjects. Studies were grouped into five different strategies: (1) physical activity ± diet; (2) anti-diabetic drugs (glitazones, metformin, glinides, alfa-glucosidase inhibitors); (3) antihypertensive drugs (ACE inhibitors, ARB); (4) weight loss-promoting drugs and lipid-lowering drugs (orlistat, bezafibrate, phentermine/topiramate controlled release); and (5) bariatric surgery. Only controlled studies, dealing with subjects BMI ≥ 30 kg/m2, were included in the analysis, whether randomized or non-randomized studies. Appropriate methodology (PRISMA statement) was adhered to. Publication bias was formally assessed. Eighteen studies (43,669 subjects, 30,774 with impaired glucose tolerance and/or impaired fasting glucose), published in English language as full papers, were analyzed to identify predictors of new cases of T2DM and were included in a meta-analysis (random-effects model) to study the effect of different strategies. Intervention effect (new cases of diabetes) was expressed as odds ratio (OR), with 95 % confidence intervals (CIs). In obese subjects, non-surgical strategies were able to prevent T2DM, with different effectiveness [OR from 0.44 (0.36–0.52) to 0.86 (0.80–0.92)]; in morbidly obese subjects, bariatric surgery was highly effective [OR = 0.10 (0.02–0.49)]. At meta-regression analysis, factors associated with effectiveness were weight loss, young age and fasting insulin levels. Publication bias was present only when considering all studies together. These data indicate that several strategies, with different effectiveness, can prevent T2DM in obese subjects.

Keywords

Obesity Type 2 diabetes Meta-analysis Prevention Lifestyle modifications Anti-diabetic drugs Bariatric surgery