Early Response to Preventive Strategies in the Diabetes Prevention Program
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Recommendations for diabetes prevention in patients with prediabetes include lifestyle modification and metformin. However, the significance of early weight loss and glucose measurements when monitoring response to these proven interventions is unknown.
To quantify the relationship between early measures of weight and glucose and subsequent diabetes in patients undergoing diabetes prevention interventions.
Analysis of results from a randomized controlled trial in 27 academic medical centers in the United States.
3,041 adults with hyperglycemia randomized to lifestyle (n = 1,018), metformin (n = 1,036), or placebo (n = 987) with complete follow-up in The Diabetes Prevention Program.
Independent variables were weight loss at 6 and 12 months; fasting glucose (FG) at 6 months; hemoglobin A1c (HbA1c) at 6 months; and post-load glucose at 12 months. The main outcome was time to diabetes diagnosis.
After 6 months, 604 participants developed diabetes in the lifestyle (n = 140), metformin (n = 206), and placebo (n = 258) arms over 2.7 years. In the lifestyle arm, 6-month weight loss predicted decreased diabetes risk in a graded fashion: adjusted HR (95 % CI) 0.65 (0.35–1.22), 0.62 (0.33–1.18), 0.46 (0.24–0.87), 0.34 (0.18–0.64), and 0.15 (0.07–0.30) for 0–<3 %, 3–<5 %, 5–<7 %, 7–<10 %, and ≥10 % weight loss, respectively (reference: weight gain). Attainment of optimal 6-month FG and HbA1c and 12-month post-load glucose predicted >60 % lower diabetes risk across arms. We found a significant interaction between 6-month weight loss and FG in the lifestyle arm (P = 0.038).
Weight and glucose at 6 and 12 months strongly predict lower subsequent diabetes risk with a lifestyle intervention; lower FG predicts lower risk even with substantial weight loss. Early reduction in glycemia is a stronger predictor of future diabetes risk than weight loss for metformin. We offer the first evidence to guide clinicians in making interval management decisions for high-risk patients undertaking measures to prevent diabetes.
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- Early Response to Preventive Strategies in the Diabetes Prevention Program
Journal of General Internal Medicine
Volume 28, Issue 12 , pp 1629-1636
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- diabetes prevention
- diabetes risk
- type 2 diabetes
- Industry Sectors
- Author Affiliations
- 1. The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 2. Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- 3. George Washington University, Rockville, MD, USA
- 4. Massachusetts General Hospital Diabetes Research Center and Harvard Medical School, Boston, MA, USA
- 5. Southwest American Indian Center-Arizona, NIDDK, Phoenix, AZ, USA
- 6. Department of Medicine, University of California, San Diego, CA, USA
- 7. Washington University School of Medicine, St. Louis, MO, USA
- 8. Regenstrief Institute for Health Care, Indianapolis, IN, USA
- 9. Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- 10. The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA