Evidence-based ranking of diabetes prevention in prediabetes: A comprehensive network meta-analysis of 378 randomised controlled trials.

IF 7.9 1区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Clinical and Translational Medicine Pub Date : 2026-09-01 DOI:10.1002/ctm2.70829

Bucur Maria, Eperjesi Orsolya, Panait Robert Iulian, Topala Mihaela, Babakhani Avin Aphrodite, Rancz Anett, Kói Tamás, Fazekas Karen, Obeidat Mahmoud, Papp Renáta, Ferdinándy Péter, Szentesi Andrea, Gheorghe Cristian, Hegyi Peter, Bunduc Stefania

{"title":"Evidence-based ranking of diabetes prevention in prediabetes: A comprehensive network meta-analysis of 378 randomised controlled trials.","authors":"Bucur Maria, Eperjesi Orsolya, Panait Robert Iulian, Topala Mihaela, Babakhani Avin Aphrodite, Rancz Anett, Kói Tamás, Fazekas Karen, Obeidat Mahmoud, Papp Renáta, Ferdinándy Péter, Szentesi Andrea, Gheorghe Cristian, Hegyi Peter, Bunduc Stefania","doi":"10.1002/ctm2.70829","DOIUrl":null,"url":null,"abstract":"Background: Ten percent of the global population presents impaired glucose tolerance. Although numerous interventions have been investigated to prevent type 2 diabetes (T2D), their comparative effectiveness remains uncertain. In this study, we assessed and ranked current pharmacological and non-pharmacological interventions for preventing diabetes in individuals with prediabetes.Methods: The study protocol was registered on PROSPERO (CRD42023473875). Randomised controlled trials (RCTs) reporting on adult patients with prediabetes undergoing any intervention addressing dysglycaemia were eligible. Our systematic search was conducted from database inception to 19 December 2025 in three databases (MEDLINE, Embase and Cochrane Library [CENTRAL]). Network meta-analysis was performed using the random-effect frequentist method. Our primary outcomes were the incidence of T2D, haemoglobin A1c (HbA1c), fasting plasma glucose (FPG) and 2-h glucose after the glucose oral tolerance test (2hPG) expressed as relative risk (RR) and mean difference (MD), respectively, with the corresponding 95% confidence intervals (CIs).Results: We included 378 RCTs comprising 113 122 patients. The highest risk reduction for T2D when compared with control was obtained with dual incretin-based therapy (glucagon-like peptide 1 [GLP-1] and gastric inhibitory polypeptide (GIP) receptor agonists [GLP-1 + GIP RAs]) (RR = .1, CI [.05; .21]), with GLP-1 receptor agonists (GLP-1 RAs) ranking second (RR = .26, CI [.19; .4]) followed closely by metformin plus intensive lifestyle intervention (ILI) (RR = .27, CI [.12; .64]). Only curcumin (MD = -.49, CI [-.70; -.28]), dual GLP-1 + GIP RA (MD = -.46, CI [-.63; -.29]), single GLP-1 RA (MD = -.41, CI [-.50; -.31]) and physical activity (MD = -.35, CI [-.48; -.23]) achieved >.3% HbA1c reductions after 1 year. Sulphonylureas and physical activity were most effective for the 1-year FPG decrease, while the greatest 2hPG reduction was obtained with zinc supplementation and sulphonylureas.Conclusion: Incretin-based therapies, particularly dual GLP-1 + GIP RA and single GLP-1 RA, followed by metformin together with ILI, are the most effective interventions to prevent T2D in patients with prediabetes.","PeriodicalId":10189,"journal":{"name":"Clinical and Translational Medicine","volume":"16 9","pages":"e70829"},"PeriodicalIF":7.9000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554713/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Translational Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ctm2.70829","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Ten percent of the global population presents impaired glucose tolerance. Although numerous interventions have been investigated to prevent type 2 diabetes (T2D), their comparative effectiveness remains uncertain. In this study, we assessed and ranked current pharmacological and non-pharmacological interventions for preventing diabetes in individuals with prediabetes.

Methods: The study protocol was registered on PROSPERO (CRD42023473875). Randomised controlled trials (RCTs) reporting on adult patients with prediabetes undergoing any intervention addressing dysglycaemia were eligible. Our systematic search was conducted from database inception to 19 December 2025 in three databases (MEDLINE, Embase and Cochrane Library [CENTRAL]). Network meta-analysis was performed using the random-effect frequentist method. Our primary outcomes were the incidence of T2D, haemoglobin A1c (HbA1c), fasting plasma glucose (FPG) and 2-h glucose after the glucose oral tolerance test (2hPG) expressed as relative risk (RR) and mean difference (MD), respectively, with the corresponding 95% confidence intervals (CIs).

Results: We included 378 RCTs comprising 113 122 patients. The highest risk reduction for T2D when compared with control was obtained with dual incretin-based therapy (glucagon-like peptide 1 [GLP-1] and gastric inhibitory polypeptide (GIP) receptor agonists [GLP-1 + GIP RAs]) (RR = .1, CI [.05; .21]), with GLP-1 receptor agonists (GLP-1 RAs) ranking second (RR = .26, CI [.19; .4]) followed closely by metformin plus intensive lifestyle intervention (ILI) (RR = .27, CI [.12; .64]). Only curcumin (MD = -.49, CI [-.70; -.28]), dual GLP-1 + GIP RA (MD = -.46, CI [-.63; -.29]), single GLP-1 RA (MD = -.41, CI [-.50; -.31]) and physical activity (MD = -.35, CI [-.48; -.23]) achieved >.3% HbA1c reductions after 1 year. Sulphonylureas and physical activity were most effective for the 1-year FPG decrease, while the greatest 2hPG reduction was obtained with zinc supplementation and sulphonylureas.

Conclusion: Incretin-based therapies, particularly dual GLP-1 + GIP RA and single GLP-1 RA, followed by metformin together with ILI, are the most effective interventions to prevent T2D in patients with prediabetes.

查看原文本刊更多论文

糖尿病前期预防的循证排名：378项随机对照试验的综合网络荟萃分析

背景：全球10%的人口存在糖耐量受损。虽然已经研究了许多干预措施来预防2型糖尿病（T2D），但它们的相对有效性仍然不确定。在这项研究中，我们对糖尿病前期患者预防糖尿病的现有药物和非药物干预措施进行了评估和排名。方法：研究方案在PROSPERO上注册（CRD42023473875）。随机对照试验（RCTs）报告了接受任何干预治疗血糖异常的成年糖尿病前期患者。我们的系统检索是在三个数据库（MEDLINE、Embase和Cochrane Library [CENTRAL]）中进行的，从数据库建立到2025年12月19日。网络荟萃分析采用随机效应频率法。我们的主要结局是T2D、血红蛋白A1c （HbA1c）、空腹血糖（FPG）和葡萄糖口服耐量试验（2hPG）后2小时血糖的发生率，分别以相对危险度（RR）和平均差值（MD）表示，并给出相应的95%置信区间（CIs）。结果：我们纳入了378项随机对照试验，包括113 122例患者。与对照组相比，以胰高血糖素为基础的双重治疗（胰高血糖素样肽1 [GLP-1]和胃抑制多肽（GIP）受体激动剂[GLP-1 + GIP RAs]）的T2D风险降低最高(RR = 0.1, CI [.05；21])， GLP-1受体激动剂（GLP-1 RAs）排名第二(RR = 0.26, CI [.19；[4])，其次是二甲双胍加强化生活方式干预（ILI）（RR = 0.27, CI[.12; .64]）。只有姜黄素(MD = 49, CI[2,陈霞]),双重GLP-1 + GIP RA (MD = -.46 CI[点;29]),单一GLP-1 RA (MD = .41点,可信区间[.50;。31])和体育活动(MD = .35点,CI[相关性较高;23])实现> .3%糖化血红蛋白降低后1年。磺胺脲类药物和体育活动对1年FPG降低最有效，而补充锌和磺胺脲类药物对2hPG的降低效果最大。结论：以肠促胰岛素为基础的治疗，特别是双GLP-1 + GIP RA和单GLP-1 RA，再加上二甲双胍联合ILI，是预防糖尿病前期患者T2D最有效的干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical and Translational Medicine Multiple-

CiteScore

15.90

自引率

1.90%

发文量

450

审稿时长

4 weeks

期刊介绍： Clinical and Translational Medicine (CTM) is an international, peer-reviewed, open-access journal dedicated to accelerating the translation of preclinical research into clinical applications and fostering communication between basic and clinical scientists. It highlights the clinical potential and application of various fields including biotechnologies, biomaterials, bioengineering, biomarkers, molecular medicine, omics science, bioinformatics, immunology, molecular imaging, drug discovery, regulation, and health policy. With a focus on the bench-to-bedside approach, CTM prioritizes studies and clinical observations that generate hypotheses relevant to patients and diseases, guiding investigations in cellular and molecular medicine. The journal encourages submissions from clinicians, researchers, policymakers, and industry professionals.