Impaired Glucose Tolerance and Diabetes

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Forty-nine articles on RCTs were reviewed to evaluate the effect of weight loss on fasting blood glucose and fasting insulin. 70, 362, 367 369, 373 386

387, 390-393, 403, 404, 408, 412-415, 439, 440, 446, 470, 473, 474, 482, 485, 490, 492, 493, 576, 676-678, 681, 683, 684, 689, 690, 693, 694, 696-698, 700-702, 708, 709, 712

Studies were conducted in individuals with normal blood glucose levels (fasting plasma glucose < 115 mg/dL [< 6.4mmol/L]), 367 373 386, 387 390-393 403

412, 415, 677, 678, 681, 683, 684, 689, 690, 694, 696-698, 700 in individuals with impaired glucose tolerance (fasting plasma glucose of < 140 mg/dL [7.8 mmol/L] or 2 hours postprandial plasma glucose of > 140 to < 200 mg/dL [7.8 to 11.1 mmol/L]), 70, 369 or in individuals with diabetes (fasting plasma glucose of > 140 mg/dL or 2 hours postprandial plasma blood glucose > 200mg/dL). 362, 404, 408, 413 414, 439, 440

446, 470, 473, 474, 482, 485, 490, 492, 493, 576, 676, 693, 701, 702, 708, 709, 712*

Lifestyle Trials

Of the 38 trials reviewed on the role of lifestyle in weight loss and subsequent changes in blood glucose levels, 16 were on diet alone, 70, 373, 412, 413

415, 439, 440, 576, 677, 683, 689, 693, 701, 702, 708, 709 8 dealt with physical activity alone 70, 369, 404 474 676, 678, 690 700, 8 focused on diet plus physical activity, 70, 362, 403, 446, 470 473, 681, 684 and 5 examined the role of behavior thera-

One study included diet, behav-

ior therapy and physical activity. 694 One study included diet, behavior therapy and physical activity. 694 One study 414 included diet, behavioral therapy and drug therapy. Of the 38 trials, 9 were accepted, and 29 were not considered for these reasons:

■ There was a control group that had a weight loss intervention or there was no difference in weight loss between the treatment and control

* The reviewed articles used the "old" definitions of the American Diabetes November 1997, the new ADA definitions define "impaired fasting glucose'

Association (ADA) for impaired glucose tolerance and diabetes. As of " as those individuals having a fasting plasma glucose of 110 to 125 mg/dL, and "diabetes" as those individuals having a fasting plasma glucose of > 126 mg/dL or 2 hours postprandial plasma glucose of > 200 mg/dL.

groups' 439, 446, 470, 473, 474, 482, 485, 490, 492, 493, 576, 676-678, 683, 684, 690, 693, 694, 701, 702, 708, 709

■ The dropout rate was more than 35 percent; 415

■ The results were not reported according to randomized treatment assignments; 681

■ Outcome measures were not reported separately for the obese and nonobese people who lost weight; 440

■ There was no appropriate control group; 700 or

■ The population was not overweight. 689, 690

Pharmacotherapy Trials Of the 12 pharmacotherapy trials reviewed, 8 were accepted and 4 were excluded for these reasons:

■ The main outcome of the treatment was not weight loss; 698 or

■ The drug used is not currently being recommended for weight loss. 696-698, 712

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