Interventions for Reversing Prediabetes: A Systematic Review and Meta-Analysis.

INTRODUCTION: Several interventions have been found to be effective for reversing prediabetes in adults. This systematic review and meta-analysis aims to compare the effectiveness of such interventions. METHODS: MEDLINE, Embase, and Cochrane Library databases were searched for articles published between January 1, 2000 and June 27, 2018. RCTs in adults with prediabetes, testing nonsurgical interventions lasting for ≥3 months, and reporting the number of participants achieving normal glucose levels at intervention end were eligible. The pooled risk difference and number needed to treat for achieving normoglycemia were estimated using a random-effects, arm-based network meta-analysis. The strength of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Data were obtained in 2018 and analyzed in 2019 and 2021. RESULTS: Of 54 studies included in the systematic review, 47 were meta-analyzed (n=26,460, mean age=53 years, 46% male, 31% White). Studies included 27 arms testing lifestyle modification interventions, 25 testing medications, 5 testing dietary supplements, and 10 testing Chinese medicine. There were 35 control/placebo arms. At a median follow-up of 1.6 years, more participants in the lifestyle modification groups achieved normoglycemia than those in the control (risk difference=0.18, number needed to treat=6). The strength of the evidence was strong for lifestyle modification. Over a median follow-up of 2.7 years, more participants receiving glucagon-like peptide-1 receptor agonists (risk difference=0.47, number needed to treat=2), α-glucosidase inhibitors (risk difference=0.29, number needed to treat=4), and insulin sensitizers (risk difference=0.23, number needed to treat=4) achieved normoglycemia than control. The strength of evidence was moderate for these medications. DISCUSSION: Although several pharmacological approaches can reverse prediabetes, lifestyle modification provides the strongest evidence of effectiveness and should remain the recommended approach to address this condition.

Scopolamine does not impact declarative and motor memory consolidation across a night of sleep or a day of wakefulness.

It has been proposed that normal waking levels of acetylcholine (ACH) are important for initial memory acquisition, and that decreased ACH is critical for memory consolidation. Sleep is thought to benefit memory consolidation in part due to the predominance of low ACH levels observed during non-rapid eye movement sleep. Here we examined whether sleep and ACH suppression with the cholinergic antagonist scopolamine impact declarative and motor memory consolidation across a night of sleep or a day of wakefulness. Eighty-seven participants trained on a declarative and motor memory task in the morning or evening. Following training, participants were administered a scopolamine (0.4 mg) or placebo capsule. Participants were retested on the tasks 12 h later after a day of wake or a night of sleep. Reducing ACH levels with scopolamine provided no consolidation benefit for either task. Additionally, we found that sleep had a pronounced beneficial effect for declarative, but not motor memory consolidation. Lastly, in an exploratory analysis of the relationship between motivation and memory performance, we found that indices of intrinsic motivation were associated with improved memory acquisition and consolidation. Our findings show that reducing ACH levels after memory acquisition has no impact on the consolidation of declarative or motor memories. Additionally, sleep benefitted declarative memory but not motor memory consolidation, which highlights the interesting, though uncommon, finding that performance on some tasks might not benefit from sleep. Interestingly, the future study of intrinsic motivation may be warranted given its relationship to memory acquisition and consolidation. These findings add to our understanding of how sleep and acetylcholine impact memory consolidation, and may provide some insight about the role of ACH in memory disorders such as Alzheimer's disease.

The EXCITE Trial: analysis of "noncompleted" Wolf Motor Function Test items.

OBJECTIVE: This is the first study to examine Wolf Motor Function Test (WMFT) tasks among EXCITE Trial participants that could not be completed at baseline or 2 weeks later. METHODS: Data were collected from participants who received constraint-induced movement therapy (CIMT) immediately at the time of randomization (CIMT-I, n = 106) and from those for whom there was a delay of 1 year in receiving this intervention (CIMT-D, n = 116). Data were collected at baseline and at a 2-week time point, during which the CIMT-I group received the CIMT intervention and the CIMT-D group did not. Generalized estimating equation (GEE) analyses were used to examine repeated binary data and count values. Group and visit interactions were assessed, adjusting for functional level, affected side, dominant side, age, and gender covariates. RESULTS: In CIMT-I participants, there was an increase in the proportion of completed tasks at posttest compared with CIMT-D participants, particularly with respect to those tasks requiring dexterity with small objects and total incompletes (P < .0033). Compared with baseline, 120 tasks governing distal limb use for CIMT-I and 58 tasks dispersed across the WMFT for CIMT-D could be completed after 2 weeks. Common movement components that may have contributed to incomplete tasks include shoulder stabilization and flexion, elbow flexion and extension, wrist pronation, supination and ulnar deviation, and pincer grip. CONCLUSION: CIMT training should emphasize therapy for those specific movement components in patients who meet the EXCITE criteria for baseline motor control.