Comparing the effectiveness of metformin with lifestyle modification for the primary prevention of type Ⅱ diabetes: A systematic review and meta-analysis

Background: concerning ascending trend in prevalence of chronic type Ⅱ diabetes, prevention and the development of an effective approach after recognition of at risk individuals are crucial. The aim of this study is to investigate the influence of lifestyle modification and metformin interventions in the prevention of type Ⅱ diabetes developments. Method: The search was conducted using PubMed, Google scholar, Scopus and Web of science data bases. The inclusion criteria include randomized controlled trials (RCT) which studied both lifestyle modification and metformin interventions in the population above 18 years old without history of any types of diabetes. After excluding studies with intervention time less than 6 months, systematic review and meta-analysis were performed to evaluate relative risk (RR) with confidence interval (CI) 95% of type Ⅱ diabetes development. Results: : data from 5 studies were included in meta-analysis. The population also consists of individuals with mean age of 50 years old with BMI and FBS of 35.5 and 104.7 mg/dl respectively. Participants’ range of prevention year was between 2-3 years with mean of 2.8 years. Lifestyle modification decreases the probability of the incidence of type Ⅱ diabetes by 25.3 % (RR: 0.747, 95% CI, 0.6 - 0.92) compared to the metformin intervention (p-value= 0.007). Our results indicate that long-term lifestyle modifications can prevent diabetes type Ⅱ and decrease diabetes mellitus incidence down to one-quarter in comparison to metformin. Conclusion: lifestyle modification can be more efficacious than metformin in diminishing incidence of type Ⅱ diabetes. Therefore, lifestyle modification can be a therapeutic strategy for controlling type Ⅱ diabetes incidence especially in high risk individuals.