Final Results of Diabetes Prevention Program Published

Both lifestyle changes and treatment with metformin can significantly reduce the risk of diabetes in high-risk individuals, but lifestyle intervention is more efficacious That, according to final findings from the Diabetes Prevention Program (DPP).

Results from the DPP were initially reported last August by Department of Health and Human Services Secretary Tommy G. Thompson. Now the main results have been published in the New England Journal of Medicine.

The DPP enrolled 3,234 nondiabetic patients (mean age, 51 years; mean BMI, 34.0) with elevated fasting and post-load plasma glucose concentrations. Women and members of minority groups comprised 68% and 45% of the study group, respectively. Participants were randomized to receive placebo, metformin (850 mg twice daily), or a lifestyle-modification program (goals, >/=7% weight loss and >/0 minutes of physical activity per week).

During an average follow-up of 2.8 years, diabetes incidence in the placebo, metformin, and lifestyle-modification groups was 11.0, 7.8, and 4.8 cases per 100 person-years, respectively.

Incidence of diabetes was reduced by 58% with the lifestyle intervention (95% CI, 48%-66%) and by 31% with metformin (CI, 17%-43%) compared with placebo. The reduction in diabetes incidence achieved with lifestyle intervention was significantly greater than that achieved with metformin.

During a 3-year period, the estimated number of patients needed to treat was 6.9 with the lifestyle-intervention program and 13.9 with metformin.

"Our results support the hypothesis that type 2 diabetes can be prevented or delayed in persons at high risk for the disease," the authors wrote. "These effects were similar in men and women and in all racial and ethnic groups." (Diabetes Prevention Program Research Group. N Engl J Med 2002;346:393-403.)