Lifestyle
Intervention Reduced the Incidence of Diabetes
by 58%
The diabetes prevention program and its
global implications.
Type 2 diabetes affects over 150 million adults
worldwide and this figure is expected to double
over the next 25 yr. This increase will be accompanied
by a marked increase in the number of patients
with ESRD due to diabetes.
We hypothesized that a lifestyle-intervention
program or the administration of metformin would
prevent or delay the development of diabetes We
randomly assigned 3234 nondiabetic persons with
elevated fasting and postload plasma glucose concentrations
to placebo, metformin (850 mg twice daily), or
a lifestyle-modification program with the goals
of at least a 7% weight loss and at least 150
min of physical activity per week.
The mean age of the participants was 51 yr, and
the mean body mass index was 34.0 kg/m(2); 68%
were women, and 45% were members of non-Caucasian
racial/ethnic groups. The average follow-up was
2.8 yr.
The incidence of diabetes was 11.0, 7.8, and 4.8
cases per 100 person-years in the placebo, metformin,
and lifestyle groups, respectively.
The lifestyle intervention reduced the incidence
of diabetes by 58% (95% CI: 48 to 66%) and metformin
by 31% (95% CI: 17 to 43%), compared with placebo;
the lifestyle intervention was significantly more
effective than metformin.
In conclusion, lifestyle changes and treatment
with metformin both reduced the incidence of diabetes
in persons at high risk and the lifestyle intervention
was more effective than metformin. Because the
lifestyle changes worked equally in all racial/ethnic
groups in the Diabetes Prevention Program, they
should be applicable to high-risk populations
worldwide and may be able to reduce the projected
progressive rise in the incidence of diabetes
and the expected increase in ESRD.
Center for Endocrinology, Northwestern University,
The Feinberg School of Medicine, Northwestern,
Chicago, Illinois, USA.J Am Soc Nephrol. 2003
Jul;14(7 Suppl 2):S103-7.
