Effectiveness of lifestyle interventions/culturally bespoke programmes in South Asian ethnic groups targeting weight loss for prevention and/or remission of type 2 diabetes: A systematic review and meta‐analysis of intervention trials

Farhat, G., Mellor, D. D., Sattar, N. , Harvie, M., Issa, B. and Rutter, M. K. (2024) Effectiveness of lifestyle interventions/culturally bespoke programmes in South Asian ethnic groups targeting weight loss for prevention and/or remission of type 2 diabetes: A systematic review and meta‐analysis of intervention trials. Journal of Human Nutrition and Dietetics, (doi: 10.1111/jhn.13279) (PMID:38234263) (Early Online Publication)

Abstract

Background People from South Asian heritage are at high risk of type 2 diabetes, but there are limited specific strategies to prevent and manage this condition. The aim was to assess the effectiveness of culturally bespoke lifestyle programmes in South Asians that target weight loss for the prevention or remission of type 2 diabetes mellitus (T2DM). Methods We performed a systematic review and meta-analysis of intervention trials. PubMed, Scopus, MEDLINE (EBSCOhost), CINAHL, PsycINFO and CENTRAL were searched. Human intervention trials (randomised controlled trials and quasi-experimental) investigating the effect of lifestyle interventions on the prevention and remission of T2DM in South Asians were included. Studies including participants at risk of T2DM (prevention trials) and having the disease (remission trials) with duration ≥12 weeks were eligible. For prevention trials, the primary outcome was change in weight (kg) from baseline; for remission trials, it was decrease in HbA1c to non-diabetic levels (HbA1c ≤ 6.5%) without diabetes medications. Prevention trials were separated into (i) lifestyle modification advice and (ii) lifestyle modification advice including a supervised physical activity programme. Results Twenty-four trials were eligible (21 prevention trials and 3 remission trials). In T2DM prevention trials involving only lifestyle modification advice, the mean postintervention difference in weight between intervention and control groups was −0.65 kg (95% confidence interval [CI]: −1.04, −0.26; p = 0.01). Lifestyle modification advice including a physical activity programme was associated with greater decreases in weight: −1.13 kg (95% CI: −2.04, −0.21; p = 0.02). Fasting blood glucose levels were slightly lower in intervention groups for both intervention subtypes, although there was no significant change in HbA1c levels or 2-h plasma glucose levels. Diabetes remission trials showed potential acceptability but were limited in number and involved a small sample size, and some did not include a control group. Conclusions In South Asians, lifestyle interventions for prevention of T2DM offer only modest impacts on weight and glucose control and will unlikely reduce diabetes incidence. Alternative lifestyle interventions co-designed with members of the communities and aimed at both prevention and remission of T2DM must be urgently considered.

• Item Type: Articles
• Keywords: diabetes remission, South Asian population, type 2 diabetes, diet, obesity, lifestyle intervention
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Harvie, Dr Michelle and Sattar, Professor Naveed
• Authors: Farhat, G., Mellor, D. D., Sattar, N., Harvie, M., Issa, B., and Rutter, M. K.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Human Nutrition and Dietetics
• Publisher: Wiley
• ISSN: 0952-3871
• ISSN (Online): 1365-277X
• Published Online: 18 January 2024
• Copyright Holders: Copyright: © 2024 The Authors
• First Published: First published in Journal of Human Nutrition and Dietetics 2024
• Publisher Policy: Reproduced under a Creative Commons licence