title: Factors affecting the decline in incidence of diabetes in the Diabetes Prevention Program Outcomes Study (DPPOS).
abstract: During the first 7 years of the Diabetes Prevention Program Outcomes Study (DPPOS), diabetes incidence rates, when compared with the Diabetes Prevention Program (DPP), decreased in the placebo (-42%) and metformin (-25%), groups compared with the rates in the intensive lifestyle intervention (+31%) group. Participants in the placebo and metformin groups were offered group intensive lifestyle intervention prior to entering the DPPOS. The following two hypotheses were explored to explain the rate differences: "effective intervention" (changes in weight and other factors due to intensive lifestyle intervention) and "exhaustion of susceptible" (changes in mean genetic and diabetes risk scores). No combination of behavioral risk factors (weight, physical activity, diet, smoking, and antidepressant or statin use) explained the lower DPPOS rates of diabetes progression in the placebo and metformin groups, whereas weight gain was the factor associated with higher rates of progression in the intensive lifestyle intervention group. Different patterns in the average genetic risk score over time were consistent with exhaustion of susceptibles. Results were consistent with exhaustion of susceptibles for the change in incidence rates, but not the availability of intensive lifestyle intervention to all persons before the beginning of the DPPOS. Thus, effective intervention did not explain the lower diabetes rates in the DPPOS among subjects in the placebo and metformin groups compared with those in the DPP.
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado at Denver, Aurora, CO dppmail@bsc.gwu.edu.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hamman
authors.affiliation: Section on Clinical Research, Joslin Diabetes Center, Boston, MA.
authors.forename: Edward
authors.initials: E
authors.lastname: Horton
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.affiliation: Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.
authors.forename: George A
authors.initials: GA
authors.lastname: Bray
authors.affiliation: Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: Costas A
authors.initials: CA
authors.lastname: Christophi
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Jill
authors.initials: J
authors.lastname: Crandall
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Florez
authors.affiliation: Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fowler
authors.affiliation: Diabetes Research Institute, University of Miami School of Medicine, Miami, FL.
authors.forename: Ronald
authors.initials: R
authors.lastname: Goldberg
authors.affiliation: Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Kahn
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
authors.affiliation: Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: John M
authors.initials: JM
authors.lastname: Lachin
authors.affiliation: Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Murphy
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center Health Systems, Pittsburgh, PA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Venditti
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin