生活方式改变对糖尿病前期人群血糖及相关指标的Meta分析

Efficacy of lifestyle interventions to improve blood sugar and relevant indicators in people with pre-diabetes:A meta-analysis

目的评价生活方式对糖尿病前期人群血糖及相关指标干预的有效性及安全性。方法全面收集国内外1966~2013年发表的相关文献,采用Revman 5.0软件进行数据合并和敏感性分析,GRADE系统进行证据质量评价。结果纳入16项随机对照试验(n=3469)。Meta分析结果显示,与对照组相比,生活方式干预组糖尿病发生率(RR:0.61,95%CI:0.52~0.71,P<0.00001),FPG(WMD:-0.33mmol/L,95%CI:-0.53^-0.13),2hPG(WMD:-0.74mmol/L,95%CI:-1.38^-0.11),HbA1c(WMD:-0.30%,95%CI:-0.49^-0.11)及BMI(WMD:-1.03kg/m2,95%CI:-1.48^-0.58)均降低。结论糖尿病前期人群生活改变方式能防止或延缓糖尿病的发生。

Objective To evaluate efficacy of lifestyle interventions to improve blood sugar and relevant indicators in people with pre-diabetes.Methods Databases reporting domestic and international relevant studies,including MEDLINE,EMBASE,Web of Science,The Cochrane Library,CBM,China National Knowledge Infrastructure （CNKI） and Chinese VIP database from 1966 to June 2013,were collected.The data were extracted by two authors independently.Meta-analysis was carried out using review manager 5.0,and GRADEpro 3.6 software was used to conduct quality evaluation of evidence.Fixed-effects models or random-effects models were used to pool the summary relative risk （RR） and weighted mean difference （WMD）.Results 16 literatures were selected for randomized controlled study （n=3469） based on our standards for including and excluding.Meta-analysis showed that the incidences of diabetes,fasting blood glucose,postprandial plasma glucose,hemoglobin A1c,body mass index and waist circumference significantly reduced in lifestyle interventions group as compared with control group.The summary relative risk （RR） or weighted mean difference （WMD） and 95% confidence interval were as followings：incidence of diabetes（RR：0.61,95% CI：0.52～0.71,P〈0.00001）; FPG（WMD：-0.33mmol/L,95%CI：-0.53～-0.13） ; 2 hPG（WMD：-0.74 mmol/L,95%CI：-1.38～-0.11） ; HbA1c（WMD：-0.30%,95% CI：-0.49～-0.11） ; BMI（WMD：-1.03 kg/m^2,95%CI：-1.48～-0.58） ;waist circumference（WMD：-1.35 cm,95%CI：-2.34～-0.35）.Conclusion Lifestyle interventions may be a useful tool in preventing diabetes development from pre-diabetes.