Evidence-based ranking of diabetes prevention in prediabetes: A comprehensive network meta-analysis of 378 randomised controlled trials
Abstract
Background: Ten percent of the global population presents impaired glucose tolerance. Although numerous interventions have been investigated to prevent type 2 diabetes (T2D), their comparative effectiveness remains uncertain. In this study, we assessed and ranked current pharmacological and non-pharmacological interventions for preventing diabetes in individuals with prediabetes.
Methods: The study protocol was registered on PROSPERO (CRD42023473875). Randomised controlled trials (RCTs) reporting on adult patients with prediabetes undergoing any intervention addressing dysglycaemia were eligible. Our systematic search was conducted from database inception to 19 December 2025 in three databases (MEDLINE, Embase and Cochrane Library [CENTRAL]). Network meta-analysis was performed using the random-effect frequentist method. Our primary outcomes were the incidence of T2D, haemoglobin A1c (HbA1c), fasting plasma glucose (FPG) and 2-h glucose after the glucose oral tolerance test (2hPG) expressed as relative risk (RR) and mean difference (MD), respectively, with the corresponding 95% confidence intervals (CIs).
Results: We included 378 RCTs comprising 113 122 patients. The highest risk reduction for T2D when compared with control was obtained with dual incretin-based therapy (glucagon-like peptide 1 [GLP-1] and gastric inhibitory polypeptide (GIP) receptor agonists [GLP-1 + GIP RAs]) (RR = .1, CI [.05; .21]), with GLP-1 receptor agonists (GLP-1 RAs) ranking second (RR = .26, CI…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 113 participants or records.
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