Targeting the consequences of the metabolic syndrome in the Diabetes Prevention Program.
This review describes the effect of lifestyle change or metformin compared with standard care on incident type 2 diabetes and cardiometabolic risk factors in the Diabetes Prevention Program and its Outcome Study. The Diabetes Prevention Program was a randomized controlled clinical trial of intensive lifestyle and metformin treatments versus standard care in 3234 subjects at high risk for type 2 diabetes. At baseline, hypertension was present in 28% of subjects, and 53% had metabolic syndrome with considerable variation in risk factors by age, sex, and race. Over 2.8 years, type 2 diabetes incidence fell by 58% and 31% in the lifestyle and metformin groups, respectively, and metabolic syndrome prevalence fell by one-third with lifestyle change but was not reduced by metformin. In placebo- and metformin-treated subjects, the prevalence of hypertension and dyslipidemia increased during the Diabetes Prevention Program, whereas lifestyle intervention slowed these increases significantly. During long-term follow-up using modified interventions, type 2 diabetes incidence decreased to ≈5% per year in all groups. This was accompanied by significant improvement in cardiovascular disease risk factors over time in all treatment groups, in part associated with increasing use of lipid-lowering and antihypertensive medications. Thus a program of lifestyle change significantly reduced type 2 diabetes incidence and metabolic syndrome prevalence in subjects at high risk for type 2 diabetes. Metformin had more modest effects.
Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA. rgoldber@med.miami.edu
Ronald B
RB
Goldberg
Kieren
K
Mather
D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D050171:Dyslipidemias / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D015994:Incidence; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D008687:Metformin / Q000627:therapeutic use*; D015337:Multicenter Studies as Topic; D011236:Prediabetic State / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D008687:Metformin