title: Preventing the progression to type 2 diabetes mellitus in adults at high risk: a systematic review and network meta-analysis of lifestyle, pharmacological and surgical interventions.
abstract: OBJECTIVE
  Individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) have an increased risk of progression to Type 2 diabetes mellitus. The objective of this review was to quantify the effectiveness of lifestyle, pharmacological and surgical interventions in reducing the progression to Type 2 diabetes mellitus in people with IFG or IGT.
  
  
  METHODS
  A systematic review was carried out. A network meta-analysis (NMA) of log-hazard ratios was performed. Results are presented as hazard ratios and the probabilities of treatment rankings.
  
  
  RESULTS
  30 studies were included in the NMA. There was a reduced hazard of progression to Type 2 diabetes mellitus associated with all interventions versus standard lifestyle advice; glipizide, diet plus pioglitazone, diet plus exercise plus metformin plus rosiglitazone, diet plus exercise plus orlistat, diet plus exercise plus pedometer, rosiglitazone, orlistat and diet plus exercise plus voglibose produced the greatest effects.
  
  
  CONCLUSIONS
  Lifestyle and some pharmacological interventions are beneficial in reducing the risk of progression to Type 2 diabetes mellitus. Lifestyle interventions require significant behaviour changes that may be achieved through incentives such as the use of pedometers. Adverse events and cost of pharmacological interventions should be taken into account when considering potential risks and benefits.
authors: University of Sheffield, UK. Electronic address: J.W.Stevens@sheffield.ac.uk.
authors: John W
authors: JW
authors: Stevens
authors: University of Leicester, UK.
authors: Kamlesh
authors: K
authors: Khunti
authors: University of Sheffield, UK.
authors: Rebecca
authors: R
authors: Harvey
authors: University of Sheffield, UK.
authors: Maxine
authors: M
authors: Johnson
authors: University of Sheffield, UK.
authors: Louise
authors: L
authors: Preston
authors: University of Sheffield, UK.
authors: Helen Buckley
authors: HB
authors: Woods
authors: University of Leicester, UK.
authors: Melanie
authors: M
authors: Davies
authors: University of Sheffield, UK.
authors: Elizabeth
authors: E
authors: Goyder
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D001521:Behavior Therapy; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D004035:Diet Therapy; D018450:Disease Progression; D005081:Exercise Therapy; D005260:Female; D018149:Glucose Intolerance / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D011236:Prediabetic State / Q000150:complications / Q000473:pathology / Q000628:therapy*; D012306:Risk; D040242:Risk Reduction Behavior
chemical_list: D007004:Hypoglycemic Agents
keywords: Mixed treatment comparison; Network meta-analysis; Systematic review; Type 2 diabetes mellitus