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Diabetologia

pp 1–12 | Cite as

Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials

  • Anne Karen JenumEmail author
  • Idunn Brekke
  • Ibrahimu Mdala
  • Mirthe Muilwijk
  • Ambady Ramachandran
  • Marte Kjøllesdal
  • Eivind Andersen
  • Kåre R. Richardsen
  • Anne Douglas
  • Genevieve Cezard
  • Aziz Sheikh
  • Carlos A. Celis-Morales
  • Jason M. R. Gill
  • Naveed Sattar
  • Raj S. Bhopal
  • Erik Beune
  • Karien Stronks
  • Per Olav Vandvik
  • Irene G. M. van Valkengoed
Meta-Analysis

Abstract

Aims/hypothesis

Individuals of South Asian origin have a high risk of type 2 diabetes and of dying from a diabetes-attributable cause. Lifestyle modification intervention trials to prevent type 2 diabetes in high-risk South Asian adults have suggested more modest effects than in European-origin populations. The strength of the evidence of individual studies is limited, however. We performed an individual participant data meta-analysis of available RCTs to assess the effectiveness of lifestyle modification in South Asian populations worldwide.

Methods

We searched PubMed, EMBASE, Cochrane Library and Web of Science (to 24 September 2018) for RCTs on lifestyle modification interventions incorporating diet and/or physical activity in South Asian adults. Reviewers identified eligible studies and assessed the quality of the evidence. We obtained individual participant data on 1816 participants from all six eligible trials (four from Europe and two from India). We generated HR estimates for incident diabetes (primary outcome) and mean differences for fasting glucose, 2 h glucose, weight and waist circumference (secondary outcomes) using mixed-effect meta-analysis overall and by pre-specified subgroups. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence of the estimates. The study is registered with the International Prospective Register of Systematic Reviews ([PROSPERO] CRD42017078003).

Results

Incident diabetes was observed in 12.6% of participants in the intervention groups and in 20.0% of participants in the control groups. The pooled HR for diabetes incidence was 0.65 (95% CI 0.51, 0.81; I2 = 0%) in intervention compared with control groups. The absolute risk reduction was 7.4% (95% CI 4.0, 10.2), with no interactions for the pre-specified subgroups (sex, BMI, age, study duration and region where studies were performed). The quality of evidence was rated as moderate. Mean difference for lifestyle modification vs control groups for 2 h glucose was −0.34 mmol/l (95% CI −0.62, −0.07; I2 = 50%); for weight −0.75 kg (95% CI −1.34, −0.17; I2 = 71%) and for waist −1.16 cm (95% CI −2.16, −0.16; I2 = 75%). No effect was found for fasting glucose. Findings were similar across subgroups, except for weight for European vs Indian studies (−1.10 kg vs −0.08 kg, p = 0.02 for interaction).

Conclusions/interpretation

Despite modest changes for adiposity, lifestyle modification interventions in high-risk South Asian populations resulted in a clinically important 35% relative reduction in diabetes incidence, consistent across subgroups. If implemented on a large scale, lifestyle modification interventions in high-risk South Asian populations in Europe would reduce the incidence of diabetes in these populations.

Keywords

Diet Individual participant data meta-analysis Lifestyle intervention Physical activity Prevention RCT South Asians Type 2 diabetes 

Abbreviations

AMC

Academic Medical Center

DHIAAN

Diabetes Intervention Study in Hindustani Surinamese

GRADE

Grading of Recommendations, Assessment, Development and Evaluation

NNT

Number needed to treat

PODOSA

Prevention of Diabetes and Obesity in South Asians

PROSPERO

International Prospective Register of Systematic Reviews

Notes

Acknowledgements

We thank F.S. van Etten-Jamaludin (clinical librarian, Amsterdam UMC, location Academic Medical Center [AMC]) for her help with the development of the search strategy for the different databases. We also thank M. Nicolaou (AMC) and S. Quereshi (Norwegian Centre for Migration and Minority Health, Norwegian Institute of Public Health, Oslo, Norway) for their contribution to the systematic review data collection on which the present study builds [27].

Some of the data were presented as an abstract at the 54th Annual Meeting of the EASD in Berlin, 2018 (S160, Abstract 317).

Contribution statement

The present study builds on a previous systematic review in which the corresponding author was involved. RSB, KS and IGMvV conceived and initiated the meta-analysis and AKJ and IGMvV designed the current study. All authors (except RSB) involved in designing, and agreed on, the protocol for analysis. MM and IGMvV screened abstracts and later full-text studies for eligibility. MM, IGMvV and CAC-M assessed the quality of eligible studies. Data were acquired by IB and IM. IGMvV, KS, AR, MK, EA, AD, GC and AS contributed data to the study and verified preliminary results for their respective studies. IB, IM and KRR analysed the data and, together with AKJ, POV and IGMvV, interpreted the initial results. AKJ and IGMvV drafted the manuscript, with input from MM, IB, IM and POV. All authors contributed to the interpretation of data, critically revised the manuscript and approved the last version for publication. IB, IM, KRR and AKJ had full access to all the data in the study. AKJ is responsible for the integrity of the work as a whole.

Funding

The work was sponsored by the Health Program 2014-2020 from the European Union, grant number 664609 HPPJ-2014, set up to improve the prevention of diabetes in South Asians, and by the authors’ institutions: University of Oslo, Oslo, Norway (AKJ, IM, POV); Oslo Metropolitan University, Oslo, Norway (IB, KRR); and Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands (MM, EB, KS, IGMvV). The funders had no role in study design, data collection, analysis, data interpretation or writing of the paper. No pharmaceutical companies or representatives have been involved.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript. Some authors contributed to studies that were included in this systematic review. JMRG, NS, RSB, AD and AS were co-authors on the Prevention of Diabetes and Obesity in South Asians (PODOSA) trial but were not involved in its evaluation in the present study. IGMvV and KS contributed to the Diabetes Intervention Study in Hindustani Surinamese (DHIAAN), and were therefore not involved in the quality assessment in the present study. Similarly, no other co-authors who contributed their data (AR, MK, EA) were involved in the quality assessment in the present study.

Supplementary material

125_2019_4905_MOESM1_ESM.pdf (850 kb)
ESM (PDF 849 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Anne Karen Jenum
    • 1
    Email author
  • Idunn Brekke
    • 2
    • 3
  • Ibrahimu Mdala
    • 1
  • Mirthe Muilwijk
    • 4
  • Ambady Ramachandran
    • 5
    • 6
  • Marte Kjøllesdal
    • 7
  • Eivind Andersen
    • 8
  • Kåre R. Richardsen
    • 9
  • Anne Douglas
    • 10
  • Genevieve Cezard
    • 10
    • 11
  • Aziz Sheikh
    • 10
  • Carlos A. Celis-Morales
    • 12
  • Jason M. R. Gill
    • 12
  • Naveed Sattar
    • 12
  • Raj S. Bhopal
    • 10
  • Erik Beune
    • 4
  • Karien Stronks
    • 4
  • Per Olav Vandvik
    • 13
  • Irene G. M. van Valkengoed
    • 4
  1. 1.General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway
  2. 2.Centre for Welfare and Labour Research, Norwegian Social ResearchOsloMet – Oslo Metropolitan UniversityOsloNorway
  3. 3.Faculty of Health Sciences, Department of Nursing and Health PromotionOsloMet – Oslo Metropolitan UniversityOsloNorway
  4. 4.Department of Public Health, Amsterdam Public Health Research InstituteUniversity of AmsterdamAmsterdamthe Netherlands
  5. 5.India Diabetes Research FoundationChennaiIndia
  6. 6.Dr. A. Ramachandran’s Diabetes HospitalsChennaiIndia
  7. 7.Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway
  8. 8.Faculty of Humanities, Sports and Educational ScienceUniversity of South-Eastern NorwayBorreNorway
  9. 9.Department of Physiotherapy, Faculty of Health SciencesOsloMet – Oslo Metropolitan UniversityOsloNorway
  10. 10.Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
  11. 11.Population and Health Research Group, School of Geography and Sustainable DevelopmentUniversity of St AndrewsFifeUK
  12. 12.Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
  13. 13.Department of MedicineInnlandet Hospital TrustGjøvikNorway

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