ReviewsLong-term effectiveness of lifestyle and behavioral weight loss interventions in adults with type 2 diabetes: A meta-analysis
Section snippets
Data sources
We developed a systematic review protocol using the Cochrane Collaboration's method (20). Using Medical Subject Headings and text words, we searched the following databases between the date indicated and August 2003: MEDLINE (1966), EMBASE (1980), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982), Educational Resources Information Center (ERIC) (1966), PsychInfo (1967), Web of Science (1981), Biosis (1969), Nutrition Abstracts and Review (1979), Cochrane Library (2002,
Results
No unpublished studies were identified (Figure 1). Two studies were excluded from our meta-analysis: one (27) fulfilled the inclusion criteria but did not provide any measure of dispersion for outcomes, and another (28) combined intervention and control groups.
The meta-analysis comprised 22 eligible studies (in 21 publications) (Table 1, Table 2); two studies were reported in one publication (43). Table 2 includes the 22 eligible studies, in addition to 15 other publications derived from the
Discussion
We found that randomized controlled trials of weight loss interventions involving diet (with or without physical activity or behavioral interventions) reported only small additional declines in weight and HbA1C level as compared with those achieved by comparison groups. A partial explanation for these small changes is that the comparison group often had moderate weight loss (up to 10.0 kg), minimizing between-group differences. Cointerventions and contamination of the comparison group, as well
Acknowledgment
The authors thank Nathalie Bousader, MD, Florence J. Dallo, MPH, and Rolanda Watkins, MPH, for assistance with abstracting data from studies. Jan Stansell, MSc, and Karla Bergerhoff, MD, were invaluable in their assistance in devising and running search strategies.
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This study was supported by the Centers for Disease Control and Prevention, Atlanta, Georgia. With regard to the contributions of Dr. Avenell, the Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Executive Health Department; however, the views expressed here are those of the authors.