title: The Stepwise Approach to Diabetes Prevention: Results From the D-CLIP Randomized Controlled Trial.
abstract: This study tests the effectiveness of expert guidelines for diabetes prevention: lifestyle intervention with addition of metformin, when required, among people with prediabetes.
  
  
  
  The Diabetes Community Lifestyle Improvement Program (D-CLIP) is a randomized, controlled, translation trial of 578 overweight/obese Asian Indian adults with isolated impaired glucose tolerance (iIGT), isolated impaired fasting glucose (iIFG), or IFG+IGT in Chennai, India. Eligible individuals were identified through community-based recruitment and randomized to standard lifestyle advice (control) or a 6-month, culturally tailored, U.S. Diabetes Prevention Program-based lifestyle curriculum plus stepwise addition of metformin (500 mg, twice daily) for participants at highest risk of conversion to diabetes at ≥4 months of follow-up. The primary outcome, diabetes incidence, was assessed biannually and compared across study arms using an intention-to-treat analysis.
  
  
  
  During 3 years of follow-up, 34.9% of control and 25.7% of intervention participants developed diabetes (P = 0.014); the relative risk reduction (RRR) was 32% (95% CI 7-50), and the number needed to treat to prevent one case of diabetes was 9.8. The RRR varied by prediabetes type (IFG+IGT, 36%; iIGT, 31%; iIFG, 12%; P = 0.77) and was stronger in participants 50 years or older, male, or obese. Most participants (72.0%) required metformin in addition to lifestyle, although there was variability by prediabetes type (iIFG, 76.5%; IFG+IGT, 83.0%; iIGT, 51.3%).
  
  
  
  Stepwise diabetes prevention in people with prediabetes can effectively reduce diabetes incidence by a third in community settings; however, people with iIFG may require different interventions.
authors: Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA mbweber@emory.edu.
authors: Mary Beth
authors: MB
authors: Weber
authors: Madras Diabetes Research Foundation, Chennai, India.
authors: Harish
authors: H
authors: Ranjani
authors: Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA.
authors: Lisa R
authors: LR
authors: Staimez
authors: Madras Diabetes Research Foundation, Chennai, India.
authors: Ranjit M
authors: RM
authors: Anjana
authors: Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA.
authors: Mohammed K
authors: MK
authors: Ali
authors: Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA.
authors: K M Venkat
authors: KM
authors: Narayan
authors: Madras Diabetes Research Foundation, Chennai, India.
authors: Viswanathan
authors: V
authors: Mohan
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000517:prevention & control*; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007194:India; D008019:Life Style; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D009765:Obesity / Q000628:therapy; D050177:Overweight / Q000628:therapy; D011236:Prediabetic State / Q000453:epidemiology* / Q000517:prevention & control*; D012959:Socioeconomic Factors; D044465:White People
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008687:Metformin