Multifactorial Lifestyle Interventions in the Primary and Secondary Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus—A Systematic Review of Randomized Controlled Trials

Competence Centre of Complementary Medicine and Naturopathy, Technische Universität München, Kaiserstr 9, 80801, Munich, Germany.
Annals of Behavioral Medicine (Impact Factor: 4.2). 08/2010; 40(1):49-64. DOI: 10.1007/s12160-010-9206-4
Source: PubMed

ABSTRACT This systematic review aims to summarize the available randomized trials of multifactorial lifestyle interventions in the primary and secondary prevention of coronary heart disease and type 2 diabetes mellitus. Randomized trials investigating the effects of lifestyle interventions including the elements of diet, physical activity, and stress management in people at increased risk for or with manifest coronary heart disease or type 2 diabetes mellitus were searched for in five electronic database and by citation tracking. Quality was assessed using the Cochrane Collaboration's risk of bias tool. Exploratory effect size calculations were performed for a variety of laboratory and clinical outcome measures. Twenty-five trials including a total of 7,703 participants met the inclusion criteria. Fifteen trials were in patients with coronary heart disease, seven in patients with type 2 diabetes mellitus, and three on primary prevention. The interventions varied greatly regarding concept, intensity, and providers. Compared to participants in "usual care" control groups, there were no consistent effects on lipid levels and blood pressure and small effects on body mass index and glycated hemoglobin (HbA1c). Composite cardiac event rates were significantly less in the intervention groups of the few trials reporting these outcomes. Mortality was also lower in the intervention groups, but the difference was not statistically significant, and confidence intervals were wide. The evidence base for multifactorial lifestyle interventions is weak. Effects on surrogate measures seem minor, but there may be clinically relevant effects on major clinical endpoints.

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    • "c o m behaviors on disease progression and development of comorbidities (eg, vascular disease) in patients with type 2 diabetes [5] [6] [7] [8] [9] [10] [11] [12] [13]. However, the benefit of lifestyle changes in reducing all-cause mortality or cardiovascular disease is less clear as the findings from these analyses are inconsistent or the data are inconclusive [5] [6] [7] [8] [9] [10] [11] [12] [13]. To our knowledge, there have been no meta-analyses that evaluated the effect of interventions that result in multiple lifestyle changes on risk factors for cardiovascular disease in patients with type 2 diabetes. "
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    ABSTRACT: 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 (
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    ABSTRACT: Huls MHJ, Van Dijk MJ, Boesten ML. Genezing van diabetes mellitus type 2? Huisarts Wet 2013;56(2):70-3. Binnen de huisartsenpraktijk bereiken steeds meer diabeten langdurige normoglykemie door leefstijlinterventies of bariatrische chirurgie. Er zijn geen landelijke richtlijnen die aangeven hoe huisartsen hiermee om moeten gaan. Uit de literatuur en onderzoek blijkt dat het beter is om van remissie, dan van genezing te spreken. Dit heeft te maken met de onderliggende pathofysiologische mechanismen, maar ook met de kans op recidief van de diabetes na remissie. Daarnaast impliceert de term ‘genezing’ dat alle tijdens de diabetes ontstane orgaanschade ook verdwenen is na realisering van normoglykemie. Ziektespecifieke (microvasculaire) en generieke complicaties (macrovasculair/cardiovasculair) blijven echter in verschillende mate bestaan, ook als er langdurig sprake is van normoglykemie. Ook lijkt er onomkeerbare weefselschade te zijn, de zogenaamde ‘metabolic memory’. Bij bariatrische chirurgie heeft men in verschillende onderzoeken aangetoond dat de mortaliteit en morbiditeit na remissie afnemen. Bij leefstijlinterventies bleek dit vooralsnog niet aantoonbaar. Wij bevelen de huisarts aan om bij remissie van diabetes mellitus type 2 de consensusrichtlijnen van de American Diabetes Association te volgen. Dit sluit aan bij de NHG-Standaarden Diabetes mellitus en CVRM, die ook verschillende risicofactoren meenemen in de overwegingen. Hierbij blijft follow-up op macrovasculaire complicaties noodzakelijk en kan men follow-up op microvasculaire complicaties verminderen, maar niet staken.
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