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Diabetes prevention

Lifestyle interventions most cost-effective approach

No differences in the preventive effect of therapies with oral glucose-lowering agents between men and women could be detected
The intake of oral glucose-lowering drugs was associated with a reduction of type 2 diabetes

Behavioural and drug interventions aiming to prevent people with prediabetes progressing to full blown type 2 diabetes are equally effective for both sexes at preventing progression and reducing weight, according to a systematic review and meta-analysis. The research by Dr Anna Glechner, Danube University Krems, Austria, and Dr Jurgen Harreiter, Medical University of Vienna, Austria, and colleagues, was published in Diabetologia.

"To the best of our knowledge, this is the first systematic review that assessed potential sex-specific differences in effects of preventive interventions in pre-diabetic people,” the authors note. “Overall, based on data from more than 5,500 men and 7,400 women, our review did not find any relevant sex-specific differences in treatment effects during one to six years of active interventions. In both sexes, lifestyle and pharmacological interventions had a beneficial preventive effect on the incidence of type 2 diabetes and weight gain."

In this new analysis, the authors searched for studies between 1980 and 2013 that explored sex-specific differences in treatment effects, and found 12 studies that matched their criteria. If published studies did not provide enough detail, they contacted authors to release unpublished data on sex-specific differences.

Compared with usual care, men and women who received lifestyle interventions had a lower rate of progression to type 2 diabetes (RR 0.60 [95% CI 0.35, 1.05] after one year; RR 0.63 [95% CI 0.51, 0.79] after three years); greater weight reduction (−2.45 kg; [95% CI −3.56, −1.33 kg] after three years); and greater reductions of fasting plasma glucose (−0.31 mmol/l [95% CI −0.48, −0.15] after three years) and 2 hours post-challenge-glucose (−0.68 mmol/l [95% CI −1.03, −0.34] after three years). No statistically significant differences in treatment effects between men and women were apparent for any outcomes (p values of all comparisons ≥0.09).

Overall, no differences in the preventive effect of therapies with oral glucose-lowering agents between men and women could be detected. However, the intake of oral glucose-lowering drugs was associated with a reduction of type 2 diabetes.

"Clinically, these findings highlight an important issue. Despite differences in age of onset, detection and burden of type 2 diabetes between men and women, the effectiveness of preventive interventions in people with prediabetes is not influenced by gender. Consequently, clinicians and prevention managers can focus on factors that are known to determine the magnitude of beneficial effects, such as adherence. Clinicians also need to focus on other aspects of sex-disparities such as the higher incidence of type 2 diabetes in middle-aged men and gaps in the quality of care between diabetic men and women."

The authors also claim that successful prevention of diabetes also has an economic impact: “In people with prediabetes who are not able to adhere to lifestyle changes, initiation of metformin is probably the next best option, but thus far, no trial evidence confirms this for non-responders to lifestyle interventions." 

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