Lifestyle changes, meds effective to prevent or delay Type 2 diabetes; no change in CVD

A lifestyle intervention program of increased physical activity, healthy eating and aiming for weight loss of 7% or more, or taking the medication metformin were effective long-term to delay or prevent Type 2 diabetes in adults with prediabetes. Neither approach, however, reduced the risk of cardiovascular disease for study participants over 21 years of the study, according to the findings of the multicenter Diabetes Prevention Program Outcomes Study (DPPOS), published today in the American Heart Association’s flagship, peer-reviewed journal Circulation.

Type 2 diabetes (T2D) is the most common form of diabetes, affecting more than 34 million people in the U.S., representing nearly 11% of the U.S. population, according to the U.S. Centers for Disease Control and Prevention’s 2020 National Diabetes Statistics Report, and cardiovascular disease (CVD) is the leading cause of death and disability among people with T2D. Type 2 diabetes occurs when the body is unable to efficiently use the insulin it makes and the pancreas is unable to produce sufficient amounts of insulin. Adults with T2D are twice as likely to die from CVD — including heart attack, stroke or heart failure — compared to adults who do not have T2D. People with T2D often have other cardiovascular disease risk factors, including being overweight or having obesity, high blood pressure or high cholesterol.

The DPPOS evaluated 21-years of follow-up (through 2019) for the 3,234 adults who participated in the original, 3-year Diabetes Prevention Program (DPP) trial. This analysis of the DPPOS was focused on determining whether the medication metformin or lifestyle intervention might reduce the risk of cardiovascular disease or the rate of major cardiac events such as heart attack, stroke or death due to cardiovascular disease.

“The risk of cardiovascular disease in people with prediabetes is increased, and CVD risk further increases over time after Type 2 diabetes develops and progresses,” said Ronald B. Goldberg, M.D., chair of the writing group for the DPPOS and a professor of medicine, biochemistry and molecular biology in the division of diabetes, endocrinology and metabolism, and senior faculty member and co-director of the Diabetes Research Institute Clinical Laboratory at the University of Miami’s Miller School of Medicine in Miami, Florida. “We were focused on assessing the impact of lifestyle or metformin interventions for prevention of Type 2 diabetes in people with prediabetes to reduce cardiovascular disease.”

The DPP was a landmark, 27-center randomized trial across the U.S. from 1996-2001 to assess how to prevent or delay the onset of T2D in people with prediabetes. Study participants were screened and accepted in the DPP based upon these criteria: initially, a 2-hour glucose reading of 140-199 mg/dL on an oral glucose tolerance test; fasting glucose levels of 95-125 mg/dL; and body mass index of 24 kg/m2 or higher.

A racially diverse group of 3,234 adults were studied in the original DPP for almost three years. The participants were an average age of 51 years, and nearly 70% of the participants were women. People in the intensive lifestyle intervention group (nutritional improvement and physical activity aimed at achieving a weight loss of 7%) reduced the incidence of developing T2D by 58%, and participants who took twice daily doses of metformin had a reduced incidence of 31% for T2D, when compared to people in the placebo group who received standard care, which included information about effective treatment and management of T2D at the time of diagnosis.

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