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

Grace Farhat, Duane d. Mellor, Naveed Sattar, Michelle Harvie, Basil Issa, Martin k. Rutter

Research output: Contribution to journalArticlepeer-review

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.
Aim: To assess the effectiveness of culturally bespoke lifestyle programmes in south Asians that target weight loss for the prevention or remission of 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 (RCTs) 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 of 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 lifestyle modification advice only, the mean post-intervention difference in weight between intervention and control groups was -0.65 Kg (95% 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, whilst there was no significant change in HbA1c levels or 2-hour plasma glucose levels.
Diabetes remission trials showed potential acceptability and but were limited in number, involved 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.

Original languageEnglish
JournalJournal of Human Nutrition and Dietetics
Early online date18 Jan 2024
DOIs
Publication statusE-pub ahead of print - 18 Jan 2024

Keywords

  • Type 2 diabetes
  • south Asian population
  • obesity
  • lifestyle intervention
  • diet
  • physical activity
  • diabetes prevention
  • diabetes remission

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