Effect of lifestyle intervention in patients with type 2 diabetes: A meta-analysis

Objective. The effect of lifestyle intervention on clinical risk factors in patients with type 2 diabetes is unclear. The aim of this meta-analysis was to evaluate the effects of comprehensive lifestyle change, such as diet, exercise, and education, on clinical markers that are risk-factors for cardiovascular disease in patients with type 2 diabetes. Methods. We searched Medline, Cochrane, EMBASE, and Google Scholar (up to August 31, 2013) for randomized controlled trials that compared standard of care (control group) with treatment regimens that included changes in lifestyle (intervention group). The primary outcome was reduction in risk factors of cardiovascular disease including body mass index (BMI), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c). Results. A total of 16 studies were included in the meta-analysis. The standardized difference in means of change from baseline significantly favored the intervention compared with the control group in BMI (-0.29; 95% CI, -0.52 to -0.06, P = 0.014), HbA1c (-0.37; 95% CI, -0.59 to -0.14, P = 0.001), SBP (-0.16: 95% CI, -0.29 to -0.03, P = 0.016), DBP (-0.27, 95% CI = -0.41 to -0.12, P < 0.001). There was no difference between the intervention and control groups in HDL-c (0.05; 95% CI, -0.10 to 0.21; P = 0.503) and LDL-c (-0.14; 95% CI, -0.29 to 0.02; P = 0.092). Conclusions. The meta-analysis found that lifestyle intervention showed significant benefit in risk factors that are known to be associated with development of cardiovascular disease in patients with type 2 diabetes. (C) 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).