53 studies were reviewed looking at lifestyle changes and medications in preventing diabetes to determine the best way to treat those at risk for diabetes. Lifestyle modification and medication can prevent people at risk of diabetes from developing the condition in the short term, but only lifestyle modification is associated with a sustained risk reduction, according to a meta-analysis published Nov. 6 in JAMA Internal Medicine. However, the benefit of lifestyle modification also declined over time, suggesting further interventions to preserve the effects are needed. The researchers extracted data encompassing 49,029 patients with prediabetes, defined as impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or both, consistent with diagnostic criteria from the American Diabetes Association. The average age of the study population was 57. At the end of the active intervention phase, lifestyle modification was associated with a 39 percent decreased risk of developing diabetes while medications were associated with a 36 percent decreased risk versus control participants. After the intervention ended and at a mean follow-up of 7.2 years, patients with a lifestyle modification were 28 percent less likely to have progressed to diabetes. Those receiving medications did not maintain a significant risk reduction following the intervention. “Combined diet alterations and physical activity proved to be more effective in reducing progression to diabetes than either strategy alone by 44 percent,” the authors pointed out. Since caloric intake and physical activity are independently associated with reduced diabetes risk, combining these can be an additive effect.

Haw, J. S., Galaviz, K. I., Straus, et al. (2017). Long-term Sustainability of Diabetes Prevention Approaches: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Internal Medicine.