title: Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta-analysis.
abstract: OBJECTIVE
  To review the evidence on interventions for reversing metabolic syndrome or preventing development of type 2 diabetes and cardiovascular disease in people with metabolic syndrome.
  
  
  METHODS
  A systematic review and Bayesian mixed treatment comparison meta-analysis was conducted. Relevant electronic bibliographic databases were searched up to January 2010. Included studies were randomized controlled trials with a follow-up of ≥24 weeks and outcomes comparing incidence of diabetes and/or cardiovascular disease, or reversal of metabolic syndrome.
  
  
  RESULTS
  A total of 16 studies met the inclusion criteria. Thirteen studies with outcome data for reversal of metabolic syndrome, involving 3907 participants, were included in the meta-analysis. Insufficient trials reported cardiovascular events/mortality, or incidence of type 2 diabetes, to conduct a meta-analysis for these outcomes. Interventions, alone or in combination, included lifestyle (diet and/or exercise) and pharmacological therapy. Using random-effect models, both lifestyle (odds ratio, OR 3.81; 95% confidence interval, CI 2.47-5.88) and pharmacological interventions (OR 1.59; 95% CI 1.04-2.45) were statistically superior compared with control for reversing metabolic syndrome. Using mixed treatment comparison methods, the probability that lifestyle interventions were the most clinically effective was 87%.
  
  
  CONCLUSIONS
  Evidence suggests that both lifestyle and pharmacological interventions can reverse metabolic syndrome. However, there is a lack of data on whether these benefits are sustained and translate into longer term prevention of diabetes and/or cardiovascular disease.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Dunkley
authors.forename: K
authors.initials: K
authors.lastname: Charles
authors.forename: L J
authors.initials: LJ
authors.lastname: Gray
authors.forename: J
authors.initials: J
authors.lastname: Camosso-Stefinovic
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
authors.forename: K
authors.initials: K
authors.lastname: Khunti
mesh_terms: D001499:Bayes Theorem; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications* / Q000628:therapy*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D040242:Risk Reduction Behavior
chemical_list: D007004:Hypoglycemic Agents