Maula, A., Kai, J., Woolley, A. K., Weng, S., Dhalwani, N., Griffiths, Frances, Khunti, K. and Kendrick, D. (2020) Educational weight loss interventions in obese and overweight adults with type 2 diabetes : a systematic review and meta‐analysis of randomized controlled trials. Diabetic Medicine, 37 (4). pp. 623-635. doi:10.1111/dme.14193 ISSN 0742-3071.

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Abstract

Aim
The worldwide prevalence of type 2 diabetes mellitus is increasing, with most individuals with the disease being overweight or obese. Weight loss can reduce disease‐related morbidity and mortality and weight losses of 10–15 kg have been shown to reverse type 2 diabetes. This review aimed to determine the effectiveness of community‐based educational interventions for weight loss in type 2 diabetes.

Methods
This is a systematic review and meta‐analysis of randomized controlled trials (RCT) in obese or overweight adults, aged 18–75 years, with a diagnosis of type 2 diabetes. Primary outcomes were weight and/or BMI. CINAHL, MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to June 2019. Trials were classified into specified a priori comparisons according to intervention type. A pooled standardized mean difference (SMD) (from baseline to follow‐up) and 95% confidence intervals (95% CI) between trial groups (difference‐in‐difference) were estimated through random‐effects meta‐analyses using the inverse variance method. Heterogeneity was quantified using I2 and publication bias was explored visually using funnel plots.

Results
Some 7383 records were screened; 228 full‐text articles were assessed and 49 RCTs (n = 12 461 participants) were included in this review, with 44 being suitable for inclusion into the meta‐analysis. Pooled estimates of education combined with low‐calorie, low‐carbohydrate meal replacements (SMD = –2.48, 95% CI –3.59, –1.49, I2 = 98%) or diets (SMD = –1.25, 95% CI –2.11, –0.39, I2 = 95%) or low‐fat meal replacements (SMD = –1.15, 95%CI –2.05, –1.09, I2 = 85%) appeared most effective.

Conclusion
Low‐calorie, low‐carbohydrate meal replacements or diets combined with education appear the most promising interventions to achieve the largest weight and BMI reductions in people with type 2 diabetes.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Diabetes, Diabetes -- Diet therapy -- Study and teaching, Weight loss, Obesity
Journal or Publication Title:	Diabetic Medicine
Publisher:	Wiley
ISSN:	0742-3071
Official Date:	17 March 2020
Dates:	Date Event 17 March 2020 Published 30 November 2019 Available 28 November 2019 Accepted
Volume:	37
Number:	4
Page Range:	pp. 623-635
DOI:	10.1111/dme.14193
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	8 April 2020
Date of first compliant Open Access:	9 April 2020
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272 UNSPECIFIED National Institute for Health Research (Great Britain). Collaboration for Leadership in Applied Health Research and Care East Midlands http://viaf.org/viaf/28155224408584370530 UNSPECIFIED National Institute for Health Research Leicester Biomedical Research Centre UNSPECIFIED
Is Part Of:	1

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