Details of HTA project
Last updated: 15 July 2008 - Next update due: 22 July 2008
Research type: |
HTA Technology Assessment Report |
Project title: |
Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation: systematic review and economic evaluation |
Project ref: |
06/11/01 |
Cost: |
This project has been commissioned by the HTA programme on a call-off contract basis. |
Chief Investigator : |
Aberdeen HTA Group, University of Aberdeen |
Start Date: |
July 2006. |
Publication date: |
March 2009. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
Diabetes is characterised by elevated blood glucose levels, and there is international agreement on how high the level has to be before diabetes is diagnosed - a good bit above normal. So some people have blood glucose levels that are not normal, but not diabetic. Some of these people have high glucose levels only after meals, or after glucose tolerance tests (when the body's reaction to a glucose drink is tested). they are said to have impaired glucose tolerance or IGT. Others have high levels while fasting (but their glucose level after a meal may be normal. They are said to have impaired fasting glucose, IFG. IGT and IFG are important for three reasons. Firstly, they may both progress to diabetes. Secondly, both, though more so IGT, are associated with an increased risk of heart disease. Thirdly, if we were to screen for type 2 diabetes, we would find more people with IGT and IFG, depending on which screening test was used, than with diabetes. Having found them, we need to be able to advise on management. This review will examine non-pharmacological ways of reducing the risk of IGT and IFG progressing to diabetes, and will also consider ways of reducing the risk of heart disease in people diagnosed with the conditions. Many will be diagnosed not by screening, but by their own doctors, for example if they are being checked for heart disease risk, or because of a family history of diabetes. |
Abstract: |
Key question: are there clinically and cost-effective interventions which will reduce the development of diabetes in those with IGT and IFG? Interventions to be examined. 1 Weight loss in those who are overweight (BMI 26-29) or obese (BMI 30 and over), by calorie restriction, alone or combined with exercise. 2 Exercise therapies. Does exercise alone, without weight loss, lead to reduction in risk? 3 Qualitative changes in diet - i.e. without calorie restriction and weight loss. 4 All of the above depend on compliance, so we will also look for evidence on ways in which adherence to diet and exercise can be improved. 5 Ethnic differences. The risk of diabetes is higher in people of South Asian ancestry, and there is some evidence that their exercise habits may differ from indigenous Britons. We will therefore look specifically for trials in this population. Comparators. The comparator will be standard care. In primary care, this is changing because of the new contract, but in brief it will be taken as no organised screening; the usual lifestyle advice given opportunistically; and care of diabetes when it becomes symptomatic. However we propose a survey of primary care using the GPRD database, to see if there are data on recent practice. Population and subgroups. The risk of IGT and diabetes increases steeply with age, and it could be argued that only, say, the over 45s should be included. However it is likely that in addition to diabetes increasing in prevalence, there is also a reduction in age at onset. True T2DM is being seen in children. A counter-argument might be that intervention should therefore be much earlier, in the hope of establishing healthier habits at a younger age that would then persist. Subgroups of interest will be influenced by the debate on screening, but will include; - the South Asian population - those who are overweight as children and young adults - older age groups, because of the rising prevalence with age. - possibly, those with other features of the metabolic syndrome such as hypertension, central obesity and high lipids Since the remit for the review starts with the fact of IGT and IFG, and is concerned with reduction of progression to diabetes. However inevitably, the costs and benefits of treating IGT and IFG will affect the wider economics of screening, and this is considered in the economics section We will note and briefly report on any evidence for prevention of IGT and IFG. Strictly speaking that is outwith the remit, but measures to prevent IGT and IFG are probably similar to those for treating them. Similarly if we retrieve trials dealing with people with metabolic syndrome (however defined) but who do not have IGT or IFG, we will note them in passing, since potentially the interventions could reduce later IGT. The National Co-ordinating Centre for HTA commissioned this technology assessement report on behalf of the HTA Programme Director. |
MeSH* index primary terms: |
OBESITY Q-prevention-&-control; GLUCOSE-INTOLERANCE Q-metabolism; OBESITY Q-economics |
MeSH* index secondary terms: |
HUMANS; COST-BENEFIT-ANALYSIS; ADULT |
NRR* number, if applicable: |
N0484184713 (*National Research Register) |
Project Protocol: |
Project protocol (pdf format, 135 kbytes) |
URL of this page: |
http://www.hta.ac.uk/1541 |
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