Educational weight loss interventions in obese and overweight adults with type 2 diabetes: a systematic review and meta‐analysis of randomized controlled trials

Maula, Asiya; Kai, Joe; Woolley, Angharad Kate; Weng, Stephen; Dhalwani, Nafeesa; Griffiths, Francis; Khunti, Kamlesh; Kendrick, Denise

Abstract

Introduction: The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing with most individuals being overweight or obese. Weight loss can reduce disease-related morbidity and mortality, and weight losses of 10-15Kg have been shown to reverse T2DM. This review aimed to determine the effectiveness of community-based educational interventions for weight loss in T2DM.

Methods: Systematic review and meta-analysis of randomised controlled trials in obese or overweight adults, 18-75 years with a diagnosis of T2DM. Primary outcomes: weight and/or BMI. CINAHL, Medline, Embase, Scopus and Cochrane central register of controlled trials were searched from inception to June 2019. Trials were classified into specified a priori comparisons according to intervention type. A pooled standardised mean difference (from baseline to follow-up) and 95% confidence interval between trial groups (difference-in-difference) was estimated through random-effects meta-analyses using the inverse variance method. Heterogeneity was quantified using I^2 and publication bias was explored visually using funnel plots.

Results: 7,383 records were screened; 228 full text articles were assessed from which, 49 RCTs (n=12,461 participants) were included in this review with 44 being suitable for inclusion into the meta-analysis. Pooled estimates of education combined with low-calorie, low-carbohydrate meal replacements (SMD =-2.48, 95%CI -3.59,-1.49, I^2=98%) or diets (SMD = -1.25, 95% CI -2.11,-0.39, I^2=95%) or low fat meal replacements (SMD =-1.15, 95%CI -2.05,-1.09, I^2=85%) appeared most effective.

Conclusion: Low-calorie low-carbohydrate meal replacements or diets combined with education appear the most promising interventions to achieve the largest weight and BMI reductions in people with T2DM.

Citation

Maula, A., Kai, J., Woolley, A. K., Weng, S., Dhalwani, N., Griffiths, F., …Kendrick, D. (2020). Educational weight loss interventions in obese and overweight adults with type 2 diabetes: a systematic review and meta‐analysis of randomized controlled trials. Diabetic Medicine, 73(4), 623-635. https://doi.org/10.1111/dme.14193

• Journal Article Type: Article
• Acceptance Date: Oct 22, 2019
• Online Publication Date: Dec 22, 2019
• Publication Date: 2020-04
• Deposit Date: Oct 25, 2019
• Publicly Available Date: Jan 8, 2020
• Journal: Diabetic Medicine
• Print ISSN: 0742-3071
• Electronic ISSN: 1464-5491
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 73
• Issue: 4
• Pages: 623-635
• DOI: https://doi.org/10.1111/dme.14193
• Public URL: https://nottingham-repository.worktribe.com/output/2966580
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/dme.14193
• Contract Date: Oct 25, 2019