Two-hour glucose reductions and baseline levels for effective prevention of type 2 diabetes in individuals with impaired glucose tolerance: An evidence synthesis and meta-regression analysis.
To identify the optimal 2-h glucose reduction and baseline level for preventing progression from impaired glucose tolerance to type 2 diabetes using meta-regression.
We systematically reviewed randomized clinical trials of lifestyle modifications and/or anti-hyperglycemic medications reporting both 2-h glucose and diabetes prevention in impaired glucose tolerance. PubMed (1997), Cochrane Library (1995), and Ichushi-Web (Japanese medical literature database; 2000) were searched from inception through January 26, 2025. A meta-regression model examined log-transformed hazard ratios for diabetes progression, with 2-h glucose reduction and baseline level as predictors.
From 1372 candidates, 32 studies (n = 33,839 participants) were analyzed. The model indicated linear relationship and the early intervention at a baseline 2-h glucose of 140 mg/dL (7.8 mmol/L) could prevent 44% of diabetes with only a 10 mg/dL (0.56 mmol/L) reduction. Conversely, later interventions at a baseline 2-h glucose of 170-190 mg/dL (9.4-10.6 mmol/L) require larger 2-h glucose reductions of 20-30 mg/dL (1.1-1.7 mmol/L) for similar preventive effects (40-42%); which may necessitate pharmacotherapy.
This meta-regression analysis demonstrates that early and minimal interventions for impaired glucose tolerance are optimal, suggesting that its timely detection is vital for diabetes prevention.
We systematically reviewed randomized clinical trials of lifestyle modifications and/or anti-hyperglycemic medications reporting both 2-h glucose and diabetes prevention in impaired glucose tolerance. PubMed (1997), Cochrane Library (1995), and Ichushi-Web (Japanese medical literature database; 2000) were searched from inception through January 26, 2025. A meta-regression model examined log-transformed hazard ratios for diabetes progression, with 2-h glucose reduction and baseline level as predictors.
From 1372 candidates, 32 studies (n = 33,839 participants) were analyzed. The model indicated linear relationship and the early intervention at a baseline 2-h glucose of 140 mg/dL (7.8 mmol/L) could prevent 44% of diabetes with only a 10 mg/dL (0.56 mmol/L) reduction. Conversely, later interventions at a baseline 2-h glucose of 170-190 mg/dL (9.4-10.6 mmol/L) require larger 2-h glucose reductions of 20-30 mg/dL (1.1-1.7 mmol/L) for similar preventive effects (40-42%); which may necessitate pharmacotherapy.
This meta-regression analysis demonstrates that early and minimal interventions for impaired glucose tolerance are optimal, suggesting that its timely detection is vital for diabetes prevention.