Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. American Diabetes Association. Total prevalence of diabetes and pre-diabetes. American Association website. http://www.diabetes.org/diabetes-statistics/prevalence.jsp

  2. Pi-Sunyer X (2009) The medical risk of obesity. Postgrad Med 121:21–33

    Article  PubMed  PubMed Central  Google Scholar 

  3. Despres JP, Lemieux I (2006) Abdominal obesity and metabolic syndrome. Nature 444:881–887

    Article  PubMed  CAS  Google Scholar 

  4. Ford ES, Zhao G, Li C et al (2010) Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence. J Am Coll Cardiol 55:1310–1317

    Article  PubMed  Google Scholar 

  5. Cheng YJ, Gregg EW, Geiss LS et al (2009) Association of HbA1c and fasting plasma glucose level with diabetic retinopathy prevalence in the U.S. population: implication for diabetes diagnostic thresholds. Diabetes Care 32:2027–2032

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Ziegler D, Rathmann W, Dickhaus T et al (2008) Prevalence of polyneuropathy in prediabetes and diabetes is associated with abdominal obesity and macroangiopathy: the MONICA/KORA Augsburg Survey S2 and S3. Diabetes Care 31:464–469

    Article  PubMed  CAS  Google Scholar 

  7. CDC. Diabetes Fact Sheet online 2011. Jan 26.2011

  8. American Diabetes Association (2012) Standards of medical care in diabetes-2012. Diabetes Care 35:S11–S63

    Article  Google Scholar 

  9. Nathan DM, Davidson MB, DeFronzo RA et al (2007) Impaired fasting glucose and impaired glucose tolerance: implication for care. Diabetes Care 30:753–759

    Article  PubMed  CAS  Google Scholar 

  10. Brakis G, Stockert J, Molitch M et al (2009) Risk factor assessment for new onset diabetes: literature review. Diabetes Obes Metab 11:177–187

    Article  Google Scholar 

  11. Progetto Cuore. Istituto Superiore di Sanità. http://www.cuore.iss.it/fattori/glicemia.asp. Accessed 13 June 2012

  12. Whiting DR, Guariguata L, Weil C, Shaw J (2011) IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 94:311–321

    Article  PubMed  Google Scholar 

  13. Perrault L, Pan Q, Mather KJ et al (2012) Regression from pre-diabetes to normal glucose regulation is associated with long term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study. Lancet 379:2243–2251

    Article  Google Scholar 

  14. Phung OJ, Sood NA, Sill BE, Coleman CI (2011) Oral anti-diabetic drugs for the prevention of type 2 diabetes. Diabet Med 28:948–964

    Article  PubMed  CAS  Google Scholar 

  15. Knowler WC, Barrett-Connor E, Fowler SE, The Diabetes Prevention Program Research Group et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403

    Article  PubMed  CAS  Google Scholar 

  16. Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S et al (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368:1673–1679

    Article  PubMed  Google Scholar 

  17. Penn L, White M, Oldroyd J et al (2009) Prevention 006Ff type 2 diabetes in adults with impaired glucose tolerance: the European diabetes prevention RCT in newcastle upon Tyne UK. BMC Public Health 9:342

    Article  PubMed  PubMed Central  Google Scholar 

  18. Penn L, White M, Lindstrom J, den Boer A et al (2013) Importance of weight loss maintenance and risk prediction in the prevention of type 2 diabetes: analysis of the European Diabetes Prevention Study RCT. PLoS One 8:e57143

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Buchanan TA, Xiang AH, Peters RK et al (2002) Preservation of pancreatic β-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high–risk Hispanic women. Diabetes 51:2796–2803

    Article  PubMed  CAS  Google Scholar 

  20. Chiasson JL, Josse RG, Gomis R (2002) Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 359:2072–2077

    Article  PubMed  CAS  Google Scholar 

  21. Gerstein HC, Yusuf S, Bosch J, The Dream Trial Investigators et al (2006) Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet 368:1096–1105

    Article  PubMed  CAS  Google Scholar 

  22. Holman RR, Haffner SM, McMurray JJ, The NAVIGATOR Study Group et al (2010) Effect of nateglinide on the incidence of diabetes and cardiovascular events. N Engl J Med 362:1463–1476

    Article  PubMed  CAS  Google Scholar 

  23. DeFronzo RA, Tripathy D, Schwenke DC, The ACT NOW Study et al (2011) Pioglitazone for diabetes prevention in impaired glucose tolerance. N Engl J Med 364:1104–1115

    Article  PubMed  CAS  Google Scholar 

  24. Gerstein HC, Mohan V, Avezum A et al (2011) Long term effect of rosiglitazone and/or ramipril on the incidence of diabetes. Diabetologia 54:487–495

    Article  PubMed  CAS  Google Scholar 

  25. Bosch J, Yusuf S, Gerstein HC, For the Dream Trial Investigators et al (2006) Effect of ramipril on the incidence of diabetes. N Engl J Med 355:1551–1562

    Article  PubMed  Google Scholar 

  26. Mc Murray JJ, Holman RR, Haffner SM et al (2010) Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med 362:1477–1490

    Article  CAS  Google Scholar 

  27. Torgerson JS, Hauptman J, Boldrin MN et al (2004) XENical in the Prevention of Diabetes in Obese Subjects (XENDOS) Study. A randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27:155–161

    Article  PubMed  CAS  Google Scholar 

  28. Tenenbaum A, Motro M, Fisman EZ et al (2005) Effect of bezafibrate on incidence of type 2 diabetes mellitus in obese patients. Eur Heart J 26:2032–2038

    Article  PubMed  CAS  Google Scholar 

  29. Garvey T, Ryan DH, Henry R et al (2014) Prevention of type 2 diabetes in subjects with prediabetes and metabolic syndrome with phentermine and topiramate extended-release. Diabetes Care 37:912–921

    Article  PubMed  CAS  Google Scholar 

  30. Long SD, O’Brien K, MacDonald KG et al (1994) Weight loss in severely obese subjects prevents progression of impaired glucose tolerance to type II diabetes. A longitudinal interventional study. Diabetes Care 17:372–375

    Article  PubMed  CAS  Google Scholar 

  31. Pontiroli AE, Folli F, Paganelli M et al (2005) Laparoscopic gastric banding prevents type 2 diabetes and arterial hypertension and induces their remission in morbid obesity. A 4-year case-controlled study. Diabetes Care 28:2703–2709

    Article  PubMed  Google Scholar 

  32. Carlsson LM, Peltonen M, Ahlin S et al (2012) Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med 367:695–704

    Article  PubMed  CAS  Google Scholar 

  33. Yamaoka K, Tango T (2005) Efficacy of lifestyle education to prevent type 2 diabetes. A meta-analysis of randomized controlled trials. Diabetes Care 28:2780–2786

    Article  PubMed  Google Scholar 

  34. Norris SL, Zhang X, Avenell A et al (2005) Long term effectiveness of weight-loss interventions in adults with pre-diabetes. A review. Am J Prev Med 28:126–139

    Article  PubMed  Google Scholar 

  35. Lloret-Linares C, Greenfield JR, Czernichow S (2008) Effect of weight reducing agents on glycaemic parameters and progression to type 2 diabetes: a review. Diabet Med 25:1142–1150

    Article  PubMed  CAS  Google Scholar 

  36. Yates T, Khunti K, Bull F et al (2007) The role of physical activity in the management of impaired glucose tolerance: a systematic review. Diabetologia 50:1116–1126

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  37. Anderson DC (2005) Pharmacologic prevention or delay of type 2 diabetes mellitus. Ann Pharmacother 39:102–109

    Article  PubMed  CAS  Google Scholar 

  38. Padwal R, Majumdar SR, Johnson JA et al (2005) A systematic review of drug therapy to delay or prevent type 2 diabetes. Diabetes Care 28:736–744

    Article  PubMed  CAS  Google Scholar 

  39. Abuissa H, Jones PG, Marso SP, O’Keefe JH Jr (2005) Angiotensin-Converting enzyme inhibitors or angiotensin receptor blockers for prevention of type 2 diabetes. A meta-analysis of randomized clinical trials. J Am Coll Cardiol 46:821–826

    Article  PubMed  CAS  Google Scholar 

  40. Andraws R, Brown DL (2007) Effect of inhibitors of the renin-angiotensin system on the development of type 2 diabetes mellitus (meta-analysis of randomized trials). Am J Cardiol 99:1006–1012

    Article  PubMed  CAS  Google Scholar 

  41. Abuissa H, O’Keefe J (2008) The role of renin-angiotensin-aldosterone system-based therapy in diabetes prevention and cardiovascular and renal protection. Diabetes Obes Metab 10:1157–1166

    PubMed  CAS  Google Scholar 

  42. Higgins JPT, Green S (eds) (2008) Cochrane handbook for systematic reviews. Special topics in statistics: studies with more than two intervention groups. Wiley, Blackwell

    Google Scholar 

  43. Higgins JPT, Altman DG, Gotzsche PC, Juni P et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  PubMed  PubMed Central  Google Scholar 

  44. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  45. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–180

    Article  PubMed  CAS  Google Scholar 

  46. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  47. Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR (1991) Publication bias in clinical research. Lancet 337:867–872

    Article  PubMed  CAS  Google Scholar 

  48. Lim E, Ali Z, Ali A, Routledge T, Edmonds L, Altman DG, Large S (2007) Indirect comparison meta-analysis of aspirin therapy after coronary surgery. BMJ 327:1–5

    Google Scholar 

  49. Sattar N, Preiss D, Murray HM et al (2010) Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 375:735–742

    Article  PubMed  CAS  Google Scholar 

  50. Scheen AJ (2007) Antidiabetic agents in subjects with mild dysglycaemia: prevention or early treatment of type 2 diabetes? Diabetes Metab 33:3–12

    Article  PubMed  CAS  Google Scholar 

  51. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122(248–256):e5

    PubMed  Google Scholar 

  52. Arterburn DE, Bogart A, Sherwood NE, Sidney S, Coleman KJ, Haneuse S, O’Connor PJ, Theis MK, Campos GM, McCulloch D, Selby J (2013) A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg 23:93–102

    Article  PubMed  Google Scholar 

  53. Diabetes Prevention Program Research Group (2003) Effects of withdrawal from metformin on the development of diabetes in the diabetes prevention program. Diabetes Care 26:977–980

    Article  Google Scholar 

  54. Pontiroli AE, Merlotti C, Veronelli A, Lombardi F (2013) Effect of weight loss on sympatho-vagal balance in subjects with grade-3 obesity: restrictive surgery versus hypocaloric diet. Acta Diabetol 50:843–850

    Article  PubMed  CAS  Google Scholar 

  55. Folini L, Veronelli A, Benetti A, Pozzato C, Cappelletti M, Masci E, Micheletto G, Pontiroli AE (2014) Liver steatosis (LS) evaluated through chemical-shift magnetic resonance imaging liver enzymes in morbid obesity; effect of weight loss obtained with intragastric balloon gastric banding. Acta Diabetol 51(3):361–368

    Article  PubMed  CAS  Google Scholar 

  56. Adams ST, Salhab M, Hussain ZI, Miller GV, Leveson SH (2013) Preoperatively determinable factors predictive of diabetes mellitus remission following Roux-en-Y gastric bypass: a review of the literature. Acta Diabetol 50:475–478

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

Claudia Merlotti, Alberto Morabito, Valerio Ceriani and Antonio E. Pontiroli declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Cattedra di Medicina Interna and Cattedra di Statistica Medica e Biometria, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy

    Claudia Merlotti & Antonio E. Pontiroli

  2. Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy

    Alberto Morabito

  3. IRCCS Multimedica, Milan, Italy

    Valerio Ceriani

Authors
  1. Claudia Merlotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto Morabito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valerio Ceriani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio E. Pontiroli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio E. Pontiroli.

Additional information

Managed by Massimo Federici.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPT 1966 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Merlotti, C., Morabito, A., Ceriani, V. et al. Prevention of type 2 diabetes in obese at-risk subjects: a systematic review and meta-analysis. Acta Diabetol 51, 853–863 (2014). https://doi.org/10.1007/s00592-014-0624-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-014-0624-9

Keywords

Search

Navigation