Identifying Promising Practices in Lifestyle Intervention Programs for the Prediabetes Population: A Meta‐Analysis and Meta‐Regression of Randomized Controlled Trials

ABSTRACT

Background

Despite the evidence for the efficacy of lifestyle interventions for type 2 diabetes prevention, there remains a gap in translating this evidence-based practice into real-world settings.

Aims

To summarize current evidence regarding the relationship between participant characteristics, intervention components, and the effect of lifestyle interventions for individuals with prediabetes.

Methods

The initial search of PubMed, Embase, the Cochrane Library, and Web of Science was performed on 6th December 2023 and was subsequently updated on 5th October 2025. Randomized controlled trials on lifestyle interventions (diet and/or physical activity), compared to usual care, no intervention, or wait-list control, in adults with prediabetes were eligible. Outcomes included the incidence of type 2 diabetes and normoglycemia, fasting plasma glucose (FPG), 2-h plasma glucose, hemoglobin A1c (HbA1c), fasting insulin (FI), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Random-effects meta-analyses were performed to estimate relative risks (RRs) and mean differences. Subgroup analyses and meta-regressions were conducted by participant characteristics and intervention components.

Results

Seventy-seven studies (n = 22,629 participants) were included. Greater weight loss (%) was associated with larger reductions in diabetes incidence (β = 0.07 [0.02, 0.12], p = 0.010). Achieving ≥ 5% (vs. < 5%) weight loss was associated with higher reversion rates to normoglycemia (RR = 1.80 [1.55; 2.08] vs. 1.32 [1.03; 1.70]; p _subgroup = 0.036). Interventions with supervised exercise training more effectively reduced diabetes incidence than those without this component (RR = 0.40 [0.24; 0.65] vs. 0.69 [0.63; 0.76]; p _subgroup = 0.031). Younger participants showed greater improvements in FPG, HbA1c, FI, and HOMA-IR. Higher baseline HbA1c levels were associated with a greater reduction in HbA1c but a smaller FI improvement.

Linking Evidence to Action

This meta-analysis provides valuable insights into the implementation of diabetes prevention programs. Weight loss is a critical determinant for diabetes prevention, and weight loss goal setting and progress monitoring are recommended. Adding supervised exercise sessions can enhance the program's effectiveness. Early interventions for younger individuals with lower HbA1c levels may prevent diabetes more effectively.

Trial Registration

PROSPERO (CRD42024486361)