Preventing diabetes in adults with impaired glucose tolerance : lifestyle or pharmacological intervention?

Abstract

The incidence of Type 2 Diabetes Mellitus (T2DM) is rapidly increasing worldwide leading to complications that can have a traumatic impact on both patients and relatives. Individuals with impaired glucose tolerance (IGT) are at a higher risk of developing T2DM. Interventions aimed at preventing T2DM play an important role in future health policies, as these could reduce associated costs and health burden. The PICO framework was used to formulate the research question: In adults with IGT (Population), which intervention is the most effective to prevent the progression to T2DM (Outcome): lifestyle (Intervention) or pharmacological intervention (comparison)? A systematic literature search strategy using various keywords and databases was used to generate information that could answer the question. Relevant studies were selected against an inclusion and exclusion criteria. The search was restricted to English-language systematic reviews and randomised controlled trials with individuals with IGT. It excluded studies which included individuals taking medication known to alter glucose tolerance. The Critical Appraisal Skills Programme was the tool used to appraise the key papers. The trials reviewed indicated that all the interventions investigated were effective in reducing T2DM incidence. Evidence regarding which intervention is the most effective remains inconclusive, pointing out to the need for further research in this area. However, since lifestyle-interventions provided additional benefits and had less serious side effects than pharmacotherapy, lifestyle may be the intervention of choice. Locally, public awareness and screening methods should improve to aid in the identification of individuals at high-risk. Furthermore, diabetes prevention programmes should be multisectorial and should include further recruitment and training of health professionals who are needed to support individuals at risk.