Lifestyle Modification, Metformin
Effective Prevention for Type 2 Diabetes
According to a recent American study, lifestyle
modification or metformin treatment can prevent
the development of type 2 diabetes in individuals
at high risk for the disease
Type 2 diabetes affects approximately 4% of adults
worldwide, and this rate is expected to grow rapidly
in the coming years. Treatment of diabetes can
prevent some complications, but cannot usually
restore glycemic levels to normal or reverse nephropathy,
and prevention is clearly a more desirable approach.
Several studies have demonstrated that the development
of diabetes is associated with weight gain and
low levels of physical activity. Based on these
observations, it has been suggested that lifestyle
modification may be effective for preventing diabetes
in susceptible individuals.
To evaluate potential prevention approaches for
type 2 diabetes, the Diabetes Prevention Program
Research Group conducted a large, multi-center
clinical trial involving adults who were at high
risk for development of the disease. The researchers
analyzed both metformin treatment and lifestyle
modification.
Nondiabetic, high-risk individuals were identified
who were older than 25 years, had body mass index
(BMI) of kg/m2 or greater, and had an impaired
glucose tolerance with elevated fasting glucose
levels. Participants had a mean age of 51 years
and 68% were women. They were randomly assigned
to one of three intervention treatments: 1,073
patients were prescribed 850 mg metformin twice
daily, 1,082 had placebo twice daily, and 1,079
were prescribed an intensive program of lifestyle
modification. Patients were followed for a mean
of 2.8 years.
The goals for the intensive lifestyle program
were to achieve and maintain a weight reduction
of at least 7% of initial body weight through
a healthy diet and moderate physical activity
of at least 150 minutes per week.
Cumulative incidence of diabetes was significantly
lower in the metformin and lifestyle intervention
groups than in the placebo group throughout the
follow-up period, with crude incidence rates of
11.0, 7.8, and 4.8 cases per 100 person-years
for placebo, metformin, and lifestyle intervention
groups, respectively.
Incidence of diabetes was 58% lower (95% CI:
48-66%) in the lifestyle intervention group and
31% lower (95% CI; 17-43%) in the metformin group
than in the placebo group.
Lifestyle intervention was highly effective in
all subgroups, regardless of gender, race or ethnicity.
In contrast, metformin was less effective in individuals
with a BMI below 30 kg/m2 or those who were older
than 60 years.
The researchers conclude, "Metformin and
modification of lifestyle were two highly effective
means of delaying or preventing type 2 diabetes,"
and "the lifestyle intervention was particularly
effective."
They propose, "It should be possible to
delay or prevent the development of diabetic nephropathy
and other complications, substantially reducing
the individual and public health burden of diabetes,"
and note that a longer-term follow-up study is
currently underway to evaluate these issues. J
Am Soc Nephrol 2003 Jul;14:7 Suppl 2:S103-7
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DID
YOU KNOW:
The
Diabetes Education Society offers online
accredited continuing education programs. Got
an hour, take a course. Visit www.MedEdOps.org,
take the free sample course and review the Course
Catalog. Then update yourself and your staff to
meet your Education Recognition requirements.
For more information call (800) 659-5808.
If
you are going to be at the AADE Conference in
Salt Lake City then stop by and meet Dr. Paul
Chous on Thursday or Friday
