title: Effect of lifestyle interventions on glucose regulation among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis.
abstract: This study systematically assessed the effectiveness of lifestyle interventions on glycemic indicators among adults (⩾18years) without IGT or diabetes. Randomized controlled trials using physical activity (PA), diet (D), or their combined strategies (PA+D) with follow-up ⩾12months were systematically searched from multiple electronic-databases between inception and May 4, 2016. Outcome measures included fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), fasting insulin (FI), homeostasis model assessment-estimated insulin resistance (HOMA-IR), and bodyweight. Included studies were divided into low-range (FPG <5.5mmol/L or HbA1c <5.5%) and high-range (FPG ⩾5.5mmol/L or HbA1c ⩾5.5%) groups according to baseline glycemic levels. Seventy-nine studies met inclusion criteria. Random-effect models demonstrated that compared with usual care, lifestyle interventions achieved significant reductions in FPG (-0.14mmol/L [95%CI, -0.19, -0.10]), HbA1c (-0.06% [-0.09, -0.03]), FI (%change: -15.18% [-20.01, -10.35]), HOMA-IR (%change: -22.82% [-29.14, -16.51]), and bodyweight (%change: -3.99% [-4.69, -3.29]). The same effect sizes in FPG reduction (0.07) appeared among both low-range and high-range groups. Similar effects were observed among all groups regardless of lengths of follow-up. D and PA+D interventions had larger effects on glucose reduction than PA alone. Lifestyle interventions significantly improved FPG, HbA1c, FI, HOMA-IR, and bodyweight among adults without IGT or diabetes, and might reduce progression of hyperglycemia to type 2 diabetes mellitus.
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: xbz2@cdc.gov.
authors.forename: Xuanping
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: gai5@cdc.gov.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
authors.affiliation: Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: bxt2@cdc.gov.
authors.forename: William
authors.initials: W
authors.lastname: Thomas
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: ycc1@cdc.gov.
authors.forename: Yiling J
authors.initials: YJ
authors.lastname: Cheng
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: felipelobelo@emory.edu.
authors.forename: Felipe
authors.initials: F
authors.lastname: Lobelo
authors.affiliation: Health Policy and Administration, Fulton-DeKalb Hospital Authority, Atlanta, GA, USA. Electronic address: dr.kerinorris@gmail.com.
authors.forename: Keri
authors.initials: K
authors.lastname: Norris
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: jji3@cdc.gov.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Devlin
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: mkali@emory.edu.
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Ali
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: inf6@cdc.gov.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gruss
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: bfb7@cdc.gov.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bardenheier
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: igz1@cdc.gov.
authors.forename: Pyone
authors.initials: P
authors.lastname: Cho
authors.affiliation: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: vpr5@cdc.gov.
authors.forename: Isabel
authors.initials: I
authors.lastname: Garcia de Quevedo
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: umamudaliar@gmail.com.
authors.forename: Uma
authors.initials: U
authors.lastname: Mudaliar
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: zna2@cdc.gov.
authors.forename: Jinan
authors.initials: J
authors.lastname: Saaddine
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: lsg2@cdc.gov.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Geiss
authors.affiliation: Division of Diabetes Translation, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: edg7@cdc.gov.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D018149:Glucose Intolerance / Q000628:therapy*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose
keywords: Glucose regulation; Lifestyle intervention; Meta-analysis; Systematic review