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Diet and exercise counseling does not reduce cardiovascular or all-cause mortality associated with prediabetes and type 2 diabetes
Clinical Question
Does intensive diet and exercise counseling affect mortality in patients with prediabetes or type 2 diabetes?
Bottom line
In relatively young older people (if there is such a category), intensive lifestyle counseling regarding diet and physical activity produced no significant benefit on all-cause or cardiovascular mortality over an average 4.25 years of follow-up. There might be a benefit seen over longer periods, though the longest studies in this meta-analysis found no benefit over 16 to 21 years of follow-up. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Foundation
Setting: Various (meta-analysis)
Synopsis
To identify eligible studies, these researchers searched 4 databases, including Cochrane Central, as well as study trial registries, and reference lists, and contacted the authors of published and unpublished trials for unpublished data. They included all languages in their search. The studies must have enrolled patients with prediabetes or type 2 diabetes and included a dietary advice as the main treatment intervention along with physical exercise recommendations, which was compared with usual care or less intensive intervention. Five pairs of researchers independently selected studies for inclusion and abstracted the findings. Two researchers evaluated the studies for risk of bias, which was low for most studies. The authors identified 11 randomized controlled trials that compared intensive lifestyle interventions with usual care for at least 2 years (average = 4.25 years). Seven studies included patients with prediabetes and 4 studies included patients with diabetes. All but 1 study enrolled patients with a body mass index equating to overweight or obese. In a total of 16,554 participants (mean age 55.5 years), the incidence of all-cause mortality was not different between intervention and control groups (relative risk [RR] 0.93; 95% CI 0.85 - 1.03). Similarly, in 11,017 participants (mean age 54.5 years), lifestyle interventions were not superior to usual care in reducing cardiovascular mortality (RR 0.99; 0.79 -1.23). There was minimal heterogeneity among the study results and no evidence of publication bias. Results were not substantially different when evaluating by study quality, glycemic status, age, or type of dietary and physical exercise recommendations.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Questionable usefulness of conclusions
Not clear from the synopsis what the ‘usual care’ consisted of (typically would include some lifestyle advice, so how much more intensive was the intervention?); also unclear whether or not the intervention was associated with behavioural change (& therefore whether desired behavioural change would have had a beneficial effect, I.e. was counselling ineffective in eliciting behavioural change or was behavioural change ineffective in altering outcome). Mortality as sole outcome measure in a relatively young group over (on average) a short period also seems to be a limitation, as baseline mortality would presumably be low; inclusion of other outcomes would seem a more realistic indicator of effectiveness of a lifestyle intervention in a group that is still in middle age (on average).
Diet and Exercise counselling in DM2
May have been more relevant to look at actual life style changes rather than counselling. Every one knows most people don't listen to what we say.
Diet and exercise counselling in DM2
I agree with the Feb.6/23 Anonymous comments above. Evidence has shown that tighter diabetic control slows the development of complications of DM2.
diet and exercise
If one believes, as I do, that T2DM is the end stage of a metabolic disease that starts with Insulin resistance decades earlier then it is discouraging but not surprising that late interventions that produce minimal change in BMI will change Mortality,
Standard American "food" and inactivity start the process of insulin resistance in childhood. By The 4th decade the majority have this disease .
health care self
word is still out on this
prediabetic advice
It's one thing to offer advice, but taking that advice by patients can be a very frustrating exercise at times, as I recall from my days of family practice. Pediatrics has been more satisfying in this regard,
Impact assessment
Very good
diabète
Offrir un counseling est une bonne chose, mais il aurait été plus pertinent d'évaluer la mortalité chez les individus qui utilisent ce counseling pour modifier réellement leurs habitudes de vie.