• Karla I Galaviz, Mary Beth Weber, Kara Suvada, Unjali P Gujral, Jingkai Wei, Rozina Merchant, Sahrudh Dharanendra, J Sonya Haw, NarayanK M VenkatKMVHubert Department of Global Health (HDGH), Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Family and Preventime Medicine and the Emory University School of Medicine, Atlanta, Georgia., and Mohammed K Ali.
• From the Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana. Electronic address: kgalaviz@iu.edu.
• Am J Prev Med. 2022 Apr 1; 62 (4): 614625614-625.

IntroductionSeveral interventions have been found to be effective for reversing prediabetes in adults. This systematic review and meta-analysis aims to compare the effectiveness of such interventions.MethodsMEDLINE, Embase, and Cochrane Library databases were searched for articles published between January 1, 2000 and June 27, 2018. RCTs in adults with prediabetes, testing nonsurgical interventions lasting for ≥3 months, and reporting the number of participants achieving normal glucose levels at intervention end were eligible. The pooled risk difference and number needed to treat for achieving normoglycemia were estimated using a random-effects, arm-based network meta-analysis. The strength of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Data were obtained in 2018 and analyzed in 2019 and 2021.ResultsOf 54 studies included in the systematic review, 47 were meta-analyzed (n=26,460, mean age=53 years, 46% male, 31% White). Studies included 27 arms testing lifestyle modification interventions, 25 testing medications, 5 testing dietary supplements, and 10 testing Chinese medicine. There were 35 control/placebo arms. At a median follow-up of 1.6 years, more participants in the lifestyle modification groups achieved normoglycemia than those in the control (risk difference=0.18, number needed to treat=6). The strength of the evidence was strong for lifestyle modification. Over a median follow-up of 2.7 years, more participants receiving glucagon-like peptide-1 receptor agonists (risk difference=0.47, number needed to treat=2), α-glucosidase inhibitors (risk difference=0.29, number needed to treat=4), and insulin sensitizers (risk difference=0.23, number needed to treat=4) achieved normoglycemia than control. The strength of evidence was moderate for these medications.DiscussionAlthough several pharmacological approaches can reverse prediabetes, lifestyle modification provides the strongest evidence of effectiveness and should remain the recommended approach to address this condition.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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