title: The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program outcomes study 10-year follow-up.
abstract: BACKGROUND
  Gestational diabetes (GDM) confers a high risk of type 2 diabetes. In the Diabetes Prevention Program (DPP), intensive lifestyle (ILS) and metformin prevented or delayed diabetes in women with a history of GDM.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the impact of ILS and metformin intervention over 10 years in women with and without a history of GDM in the DPP/Diabetes Prevention Program Outcomes Study.
  
  
  METHODS
  This was a randomized controlled clinical trial with an observational follow-up.
  
  
  METHODS
  The study was conducted at 27 clinical centers.
  
  
  METHODS
  Three hundred fifty women with a history of GDM and 1416 women with previous live births but no history of GDM participated in the study. The participants had an elevated body mass index and fasting glucose and impaired glucose tolerance at study entry.
  
  
  METHODS
  Interventions included placebo, ILS, or metformin.
  
  
  METHODS
  Outcomes measure was diabetes mellitus.
  
  
  RESULTS
  Over 10 years, women with a history of GDM assigned to placebo had a 48% higher risk of developing diabetes compared with women without a history of GDM. In women with a history of GDM, ILS and metformin reduced progression to diabetes compared with placebo by 35% and 40%, respectively. Among women without a history of GDM, ILS reduced the progression to diabetes by 30%, and metformin did not reduce the progression to diabetes.
  
  
  CONCLUSIONS
  Women with a history of GDM are at an increased risk of developing diabetes. In women with a history of GDM in the DPP/Diabetes Prevention Program Outcomes Study, both lifestyle and metformin were highly effective in reducing progression to diabetes during a 10-year follow-up period. Among women without a history of GDM, lifestyle but not metformin reduced progression to diabetes.
authors.affiliation: MedStar Health Research Institute (V.R.A., R.E.R.), Hyattsville, Maryland 20782; George Washington University Biostatistics Center (C.A.C., S.L.E.), Rockville, Maryland 20852; Centers for Disease Control and Prevention (P.Z., X.Z.), Atlanta, Georgia 30333; University of Michigan (W.H.H.), Ann Arbor, Michigan 48109; University of California, San Diego (E.B.-C.), La Jolla, California 92093; Massachusetts General Hospital and Harvard Medical School (L.M.D.), Boston, Massachusetts 02114; University of Texas Health Science Center at San Antonio (M.G.M.), San Antonio, Texas 78229; Northwestern University Feinberg School of Medicine (R.T.A.), Chicago, Illinois 60611; and National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014.
authors.forename: V R
authors.initials: VR
authors.lastname: Aroda
authors.forename: C A
authors.initials: CA
authors.lastname: Christophi
authors.forename: S L
authors.initials: SL
authors.lastname: Edelstein
authors.forename: P
authors.initials: P
authors.lastname: Zhang
authors.forename: W H
authors.initials: WH
authors.lastname: Herman
authors.forename: E
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: L M
authors.initials: LM
authors.lastname: Delahanty
authors.forename: M G
authors.initials: MG
authors.lastname: Montez
authors.forename: R T
authors.initials: RT
authors.lastname: Ackermann
authors.forename: X
authors.initials: X
authors.lastname: Zhuo
authors.forename: W C
authors.initials: WC
authors.lastname: Knowler
authors.forename: R E
authors.initials: RE
authors.lastname: Ratner
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000628:therapy; D005500:Follow-Up Studies; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D015994:Incidence; D008019:Life Style; D008687:Metformin / Q000008:administration & dosage; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin