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Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among People at Increased Risk: A Systematic Review for the Community Preventive Services Task Force
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  • Alternative Title:
    Ann Intern Med
  • Description:

    Trials have demonstrated the efficacy of rigorous diet and physical activity promotion (D&PA) programs for adults at increased risk for type 2 diabetes to reduce diabetes incidence and improve measures of glycemia.


    To evaluate D&PA programs for individuals at increased risk for type 2 diabetes primarily to lower diabetes risk, lower body weight, and improve glycemia.

    Data Sources

    MEDLINE, Cochrane Central Register of Controlled Trials, CAB Abstracts, Global Health, and Ovid HealthStar from 1991 through 27 February 2015, with no language restriction.

    Study Selection

    8 researchers screened articles for single group or comparative studies of combined D&PA programs with at least 2 sessions of at least 3 month duration in participants at increased risk for type 2 diabetes.

    Data Extraction

    7 researchers extracted data—on study design, participant, intervention, outcome descriptions, and results—and assessed study quality.

    Data Synthesis

    53 studies (30 D&PA vs. control, 13 more vs. less intensive, 13 in single programs) evaluated 66 programs. Compared with usual care, D&PA reduced type 2 diabetes incidence (RR = 0.59; 95% CI 0.51, 0.66; 16 studies), lowered body weight (net change = −2.2%; 95% CI −2.9, −1.4; 24 studies) and fasting blood glucose (net change = −0.12 mmol/L; 95% CI −0.20, −0.05; 17 studies), and improved other cardiometabolic risk factors. There was limited evidence for clinical events. More intensive programs were more effective.


    The wide variation in D&PA programs limited identification of features most relevant to effectiveness. Evidence on clinical outcomes and in children was sparse.


    Combined D&PA promotion programs are effective to decrease diabetes incidence and improve cardiometabolic risk factors for patients at increased risk. More intensive programs are more effective.

    Primary Funding Source

    Centers for Disease Control and Prevention Community Preventive Services Task Force.

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