Efficacy Of Medication Versus Intensive Lifestyle Intervention In People With Pre-diabetes: A Meta-analysis

Objective: To systematically evaluate the efficacy of medication versus intensive lifestyle(ILS) interventions in treating pre-diabetes.Methods: The Pub Med, Cochrane Library, OVID, Embase, CBM,CNKI, VIP, and Wan-fang databases were searched up to March 2016 to collect the English and Chinese literature about randomized controlled trials(RCTs) of medication(the experimental group) versus ILS(the control group) in intervening pre-diabetes(PD). Relevant reviews,conference of the included literature were retrieved manually. The reviewers screened the literature, extracted the data and assessed the quality according to the method of Cochrane systematic review, and conducted Meta-analysis with Rev Man5.3 software. Compared the incidence of diabetes,the control rate of pre-diabetes, fasting plasma glucose(FPG),2-hour postprandial glucose(2h PG), lipid[triglycerides(TG),total cholesterol(TC)], blood pressure[systolic blood pressure(SBP),diastolic blood pressure(DBP) ] and body mass index(BMI) between the experimental group and the control group.Results: We have searched 2272 literature, including 498 Chinese literature and 1774 English literature. Through removing duplicate documents, screening and rescreening those literature, we ultimately have16 literature included. A total of 20 RCTs. Meta-analysis showed that the experimental group led to better efficacy in the incidence of diabetes than the control group [RR=0.38, 95%CI=(0.25, 0.57),P<0.00001](P≦0.05),the same as the control rate of pre-diabetes [RR=1.85, 95%CI=(1.33,2.57),P=0.0002](P≦0.05). The experimental group led to greater reduction in FPG, 2h PG, TG, TC, SBP and BMI compared to the control group[FPG:MD=0.48, 95%CI=(0.33,0.63),P<0.000 01; 2h PG: MD=1.11, 95%CI=(0.90,1.33),P<0.000 01; TG: MD=0.32, 95%CI=(0.20,0.44),P<0.00001;TC: MD=0.14, 95%CI=(0.06,0.21),P=0.0003; SBP: MD=2.74,95%CI=(0.87,4.61),P=0.004; BMI: MD=0.50, 95%CI=(0.23,0.77),P=0.0003](P≦0.05). There was no statistical difference in DBP[MD=-0.45, 95%CI=(-2.43,1.53),P=0.66](P>0.05).Conclusion: It is suggested that early medication interventions,like acarbose, metformin and other hypoglycemic agents is more effective in reducing blood sugar and relevant indicators, which may be a useful tool in preventing diabetes development from pre-diabetes than ILS.