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Drug and lifestyle interventions reduce the risk of type 2 diabetes among patients with impaired glucose tolerance, and advice on diet and exercise is at least as effective as prescribing medication, Clare L. Gillies and associates reported.
The meta-analysis of 17 randomized controlled trials involving more than 8,000 patients with impaired glucose tolerance showed that pharmacologic and lifestyle (diet and exercise) interventions reduced the risk of progression to diabetes. Pooled hazard ratios were 0.44 for treatment with the antiobesity drug orlistat vs. placebo, 0.51 for lifestyle intervention vs. no intervention, and 0.70 for oral diabetes drugs vs. placebo.
“The increase in obesity and decrease in physical activity in Westernized societies are strongly linked with the increase in the prevalence and incidence of type 2 diabetes,” wrote Ms. Gillies, a medical statistician at the University of Leicester (England), and colleagues. “Lifestyle interventions, which aim to reduce obesity and increase physical activity, help to directly address these risk factors.”
In the control arms of the studies, the cumulative incidence of diabetes over 5 years was 37.1%. Based on the risk reduction in the intervention groups, the absolute reduction in diabetes incidence was 18.4 percentage points with orlistat, 15.8 percentage points with lifestyle intervention, and 9.3 percentage points with oral diabetes drugs (BMJ 2007 Jan. 19 [Epub doi:10.1136/bmj.39063.689375.55]).
The number of patients needed to treat to avert or delay one case of diabetes was 5.4 for orlistat, 6.4 for lifestyle, and 10.8 for oral diabetes drugs.
The researchers acknowledged that the results for lifestyle interventions were affected by the baseline body mass index of patients in the trials. For every one unit of mean body mass index of the trial participants, the hazard ratio dropped by 7.3%, which increased the effective risk reduction of the intervention.
Adverse events ranged from 1.2% to 91% in the 10 studies that included pharmaceutical interventions, the researchers wrote.
“For pharmacological interventions, adverse effects need to be fully understood to enable potential harms and benefits to be assessed,” they wrote. “Also should what is fundamentally a lifestyle issue really be treated with a lifelong course of medication? As compliance is the key to the success of lifestyle interventions, strategies to assist compliance need to be carefully thought through and implemented.”
Drug and lifestyle interventions reduce the risk of type 2 diabetes among patients with impaired glucose tolerance, and advice on diet and exercise is at least as effective as prescribing medication, Clare L. Gillies and associates reported.
The meta-analysis of 17 randomized controlled trials involving more than 8,000 patients with impaired glucose tolerance showed that pharmacologic and lifestyle (diet and exercise) interventions reduced the risk of progression to diabetes. Pooled hazard ratios were 0.44 for treatment with the antiobesity drug orlistat vs. placebo, 0.51 for lifestyle intervention vs. no intervention, and 0.70 for oral diabetes drugs vs. placebo.
“The increase in obesity and decrease in physical activity in Westernized societies are strongly linked with the increase in the prevalence and incidence of type 2 diabetes,” wrote Ms. Gillies, a medical statistician at the University of Leicester (England), and colleagues. “Lifestyle interventions, which aim to reduce obesity and increase physical activity, help to directly address these risk factors.”
In the control arms of the studies, the cumulative incidence of diabetes over 5 years was 37.1%. Based on the risk reduction in the intervention groups, the absolute reduction in diabetes incidence was 18.4 percentage points with orlistat, 15.8 percentage points with lifestyle intervention, and 9.3 percentage points with oral diabetes drugs (BMJ 2007 Jan. 19 [Epub doi:10.1136/bmj.39063.689375.55]).
The number of patients needed to treat to avert or delay one case of diabetes was 5.4 for orlistat, 6.4 for lifestyle, and 10.8 for oral diabetes drugs.
The researchers acknowledged that the results for lifestyle interventions were affected by the baseline body mass index of patients in the trials. For every one unit of mean body mass index of the trial participants, the hazard ratio dropped by 7.3%, which increased the effective risk reduction of the intervention.
Adverse events ranged from 1.2% to 91% in the 10 studies that included pharmaceutical interventions, the researchers wrote.
“For pharmacological interventions, adverse effects need to be fully understood to enable potential harms and benefits to be assessed,” they wrote. “Also should what is fundamentally a lifestyle issue really be treated with a lifelong course of medication? As compliance is the key to the success of lifestyle interventions, strategies to assist compliance need to be carefully thought through and implemented.”
Drug and lifestyle interventions reduce the risk of type 2 diabetes among patients with impaired glucose tolerance, and advice on diet and exercise is at least as effective as prescribing medication, Clare L. Gillies and associates reported.
The meta-analysis of 17 randomized controlled trials involving more than 8,000 patients with impaired glucose tolerance showed that pharmacologic and lifestyle (diet and exercise) interventions reduced the risk of progression to diabetes. Pooled hazard ratios were 0.44 for treatment with the antiobesity drug orlistat vs. placebo, 0.51 for lifestyle intervention vs. no intervention, and 0.70 for oral diabetes drugs vs. placebo.
“The increase in obesity and decrease in physical activity in Westernized societies are strongly linked with the increase in the prevalence and incidence of type 2 diabetes,” wrote Ms. Gillies, a medical statistician at the University of Leicester (England), and colleagues. “Lifestyle interventions, which aim to reduce obesity and increase physical activity, help to directly address these risk factors.”
In the control arms of the studies, the cumulative incidence of diabetes over 5 years was 37.1%. Based on the risk reduction in the intervention groups, the absolute reduction in diabetes incidence was 18.4 percentage points with orlistat, 15.8 percentage points with lifestyle intervention, and 9.3 percentage points with oral diabetes drugs (BMJ 2007 Jan. 19 [Epub doi:10.1136/bmj.39063.689375.55]).
The number of patients needed to treat to avert or delay one case of diabetes was 5.4 for orlistat, 6.4 for lifestyle, and 10.8 for oral diabetes drugs.
The researchers acknowledged that the results for lifestyle interventions were affected by the baseline body mass index of patients in the trials. For every one unit of mean body mass index of the trial participants, the hazard ratio dropped by 7.3%, which increased the effective risk reduction of the intervention.
Adverse events ranged from 1.2% to 91% in the 10 studies that included pharmaceutical interventions, the researchers wrote.
“For pharmacological interventions, adverse effects need to be fully understood to enable potential harms and benefits to be assessed,” they wrote. “Also should what is fundamentally a lifestyle issue really be treated with a lifelong course of medication? As compliance is the key to the success of lifestyle interventions, strategies to assist compliance need to be carefully thought through and implemented.”