Zinc supplementation for the prevention of type 2 diabetes mellitus in adults with insulin resistance

Regina El Dib; Orsi LF Gameiro; Matheus SP Ogata; Norma SP Módolo; Leandro G Braz; Eliane C Jorge; Paulo do Nascimento Junior; Vânia Beletate

doi:10.1002/14651858.CD005525.pub3

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Figure 1

Study flow diagram.

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Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Zinc supplementation versus placebo, Outcome 1 HOMA‐IR.

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Analysis 1.2

Comparison 1 Zinc supplementation versus placebo, Outcome 2 Lipids.

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Analysis 2.1

Comparison 2 Zinc supplementation versus exercise, Outcome 1 HOMA‐IR.

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Analysis 2.2

Comparison 2 Zinc supplementation versus exercise, Outcome 2 Lipids.

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Zinc supplementation for the prevention of type 2 diabetes mellitus
Population: non‐diabetic adults with insulin resistance Settings: not specified/outpatients Intervention: zinc supplementation Comparison: placebo or exercise
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Placebo or exercise	Zinc supplementation
Incidence of type 2 diabetes mellitus	See comment	See comment	See comment	See comment	See comment	Outcome not reported
Diabetic complications	See comment	See comment	See comment	See comment	See comment	Outcome not reported
Adverse events	See comment	See comment	See comment	See comment	See comment	Outcome not reported
Health‐related quality of life	See comment	See comment	See comment	See comment	See comment	Outcome not reported
All‐cause mortality	See comment	See comment	See comment	See comment	See comment	Outcome not reported
Socioeconomic effects	See comment	See comment	See comment	See comment	See comment	Outcome not reported
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

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Table 1. Overview of study populations

	Intervention(s) and comparator(s)	Sample size^a	Screened/eligible [N]	Randomised [N]	ITT [N]	Analysed [N]	Finishing study [N]	Randomised finishing study [%]	Follow‐up time^b
(1) Gómez‐García 2006	I: 100 mg/day zinc sulfate	12 (6 participants per group; 80% power)	14	7	‐	7	7	100	1 month
	C: placebo	12 (6 participants per group; 80% power)	14	7	‐	7	7	100
	total:			14	‐	14	14	100
(2) Marreiro 2006	I: 30 mg/day zinc amino chelate	‐	‐	28	‐	28	28	100	1 month
	C: placebo	‐	‐	28	‐	28	28	100
	total:			56	‐	56	56	100
(3) Soheilykhah 2012	I: 50 mg/day zinc sulfate	‐	‐	‐	‐	28	28	100	12 weeks
	C: regular exercise and weight control	‐	‐	‐	‐	25	25	100
	total:			58	‐	53	53	91.4
*Grand total*	*All interventions*			63			63
	*All comparators*			60			60
	*All interventions and comparators*			*128*			*123*
^aAccording to power calculation in study publication or report ^bDuration of intervention and/or follow‐up under randomised conditions until end of study "‐" denotes not reported C: comparator; I: intervention; ITT: intention‐to‐treat.

Table 1. Overview of study populations

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Comparison 1. Zinc supplementation versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 HOMA‐IR Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

1.1 HOMA‐IR	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Lipids Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

2.1 Total cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Total cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 HDL cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 HDL cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.5 LDL cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.6 LDL cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.7 VLDL cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.8 VLDL lipoprotein	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.9 Triglycerides	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.10 Triglycerides	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Zinc supplementation versus placebo

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Comparison 2. Zinc supplementation versus exercise

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 HOMA‐IR Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

2 Lipids Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

2.1 Total cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 HDL cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 LDL cholesterol	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 Triglycerides	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Zinc supplementation versus exercise

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