Issue 167 Item 2 Lifestyle Modification, Metformin Effective Prevention for Type

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

===============================

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