Evidence based review of type 2 diabetes prevention and management in low and middle income countries

Table 5 Diabetes prevention: Structured dietary change and exercise as main components (not lifestyle education)

Country	Ref.	Objective	Study design	Sample size/characteristics	Components of intervention	Measurements	Outcome measures	Conclusion
China	Pan et al[83]	To determine whether diet and exercise interventions will delay development of NIDDM in individuals with IGT	RCT	n = 530, control = 133, diet = 130, exercise = 141, diet + exercise = 126, > 25 yr, IGT	Diet plans, exercise recommendations with brochures on instructions on increasing leisure physical activities and counseling sessions on daily recommended food intake, weekly for one month, monthly for three months and once every three months by physicians and nurses	FBG, 2-h fasting glucose	0, 24, 48 and 72 mo	Diet and exercise led to a significant decrease in the incidence of diabetes in individuals with IGT. The diet, exercise, and diet-plus-exercise interventions were associated with 31% (P < 0.03), 46% (P < 0.0005), and 42% (P < 0.005) reductions in risk of developing diabetes, respectively
China	Xu et al[3]	Evaluate effectiveness of lifestyle intervention and meal replacement	RCT	n = 81, 41 in intervention, 40 in control, > 18 yr, IGR	Daily low-glycaemic meal replacement, individualized eating instructions, exercise recommendations, a dietician measured weekly intake and physician conducted medical evaluations	HbA1c, fasting plasma glucose, 1 hr plasma glucose	0 and 12 mo	HbA1c change was -0.12 (P = 0.02), 2 h plasma glucose change was -1.24 (P = 0.02), fasting plasma glucose change was -0.12 (P = 0.001) in intervention group, no significant changes were noted in control group
Peru	Lindgärde et al[89]	To evaluate feasibility of supervised endurance training	RCT	n = 59, 33 in control group and 26 in experimental, 25-64 yr, normal plasma fasting glucose	Structured training sessions, one per week in control group and three per week for experimental group for 60 min each approved by physiotherapist	BMI, FBG, VO2max	0 and 6 mo	Supervised exercise training is a low cost safe therapy with favorable benefits. Plasma glucose levels decreased from 5.1 mmol/L to 4.1 mmol/L (P < 0.001) in experimental group

RCT: Randomized control trial; IGT: Impaired glucose tolerance.