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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


Asiya Maula

Angharad Kate Woolley

Stephen Weng

Nafeesa Dhalwani

Francis Griffiths

Kamlesh Khunti

Professor of Primary Care Research


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.


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‚Äźanalysis of randomized controlled trials. Diabetic Medicine, 73(4), 623-635.

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
Public URL
Publisher URL