10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study
- PMID: 19878986
- PMCID: PMC3135022
- DOI: 10.1016/S0140-6736(09)61457-4
10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study
Erratum in
- Lancet. 2009 Dec 19;374(9707):2054
Abstract
Background: In the 2.8 years of the Diabetes Prevention Program (DPP) randomised clinical trial, diabetes incidence in high-risk adults was reduced by 58% with intensive lifestyle intervention and by 31% with metformin, compared with placebo. We investigated the persistence of these effects in the long term.
Methods: All active DPP participants were eligible for continued follow-up. 2766 of 3150 (88%) enrolled for a median additional follow-up of 5.7 years (IQR 5.5-5.8). 910 participants were from the lifestyle, 924 from the metformin, and 932 were from the original placebo groups. On the basis of the benefits from the intensive lifestyle intervention in the DPP, all three groups were offered group-implemented lifestyle intervention. Metformin treatment was continued in the original metformin group (850 mg twice daily as tolerated), with participants unmasked to assignment, and the original lifestyle intervention group was offered additional lifestyle support. The primary outcome was development of diabetes according to American Diabetes Association criteria. Analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00038727.
Findings: During the 10.0-year (IQR 9.0-10.5) follow-up since randomisation to DPP, the original lifestyle group lost, then partly regained weight. The modest weight loss with metformin was maintained. Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years (95% CI 4.1-5.7) in the intensive lifestyle intervention group, 7.8 (6.8-8.8) in the metformin group, and 11.0 (9.8-12.3) in the placebo group. Diabetes incidence rates in this follow-up study were similar between treatment groups: 5.9 per 100 person-years (5.1-6.8) for lifestyle, 4.9 (4.2-5.7) for metformin, and 5.6 (4.8-6.5) for placebo. Diabetes incidence in the 10 years since DPP randomisation was reduced by 34% (24-42) in the lifestyle group and 18% (7-28) in the metformin group compared with placebo.
Interpretation: During follow-up after DPP, incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group, but the cumulative incidence of diabetes remained lowest in the lifestyle group. Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years.
Funding: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Conflict of interest statement
We declare that we have no conflicts of interest.
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Comment in
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Prevention of type 2 diabetes: the long and winding road.Lancet. 2009 Nov 14;374(9702):1655-6. doi: 10.1016/S0140-6736(09)61631-7. Epub 2009 Oct 29. Lancet. 2009. PMID: 19878987 No abstract available.
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References
-
- Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–1053. - PubMed
-
- Roglic G, Unwin N, Bennett PH, et al. The burden of mortality attributable to diabetes. Diabetes Care. 2005;28:2130–2135. - PubMed
-
- Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20:1183–1197. - PubMed
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