Applying the Lessons of the DPP to Clinical Practice
- Silvio E. Inzucchi, Reviewed by, MD and
- Robert S. Sherwin, MD
STUDY
Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
SUMMARY
Objective. To determine whether improvement in risk factors for type 2 diabetes (mild hyperglycemia, overweight, sedentary lifestyle) with lifestyle change or metformin (Glucophage) can prevent or delay diabetes.
Design. A multicenter (27 sites), randomized, clinical trial.
Subjects and methods. A total of 3,324 adults with impaired glucose tolerance (IGT) and elevated fasting plasma glucose (FPG) (95–125 mg/dl) were randomized to receive placebo, metformin (850 mg twice daily), or intensive lifestyle change (weight loss ≥7% body weight and moderate physical activity ≥150 minutes per week), and followed for 3 years.
Results. At baseline, the mean age was 50.6 years, body mass index (BMI) was 34.0 kg/m2, FPG was 106.5 mg/dl, and 2-hour plasma glucose was 164.6 mg/dl. Non-white ethnic patients comprised 45% of the study population. The incidence of diabetes during an average follow-up of 2.8 years was 11.0, 7.8, and 4.8 cases per 100 person-years in the three assignment groups, respectively. The incidence of diabetes was reduced by 58% in the lifestyle group and by 31% in the metformin group.
Conclusion. Lifestyle intervention and metformin therapy both reduced the incidence of diabetes in patients at high risk, with the former being more effective than the latter.
COMMENTARY
The Diabetes Prevention Program (DPP) assessed the long-held notion that diet and exercise could prevent or delay type 2 diabetes. Using different study designs in smaller cohorts, the effectiveness of …
