Journal of General Internal Medicine

, Volume 28, Issue 12, pp 1629–1636 | Cite as

Early Response to Preventive Strategies in the Diabetes Prevention Program

  • Nisa M. Maruthur
  • Yong Ma
  • Linda M. Delahanty
  • Julie A. Nelson
  • Vanita Aroda
  • Neil H. White
  • David Marrero
  • Frederick L. Brancati
  • Jeanne M. Clark
  • for the Diabetes Prevention Program Research Group
Original Research



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.


diabetes prevention diabetes risk type 2 diabetes 

Supplementary material

11606_2013_2548_MOESM1_ESM.doc (59 kb)
ESM 1(DOC 59 kb)
11606_2013_2548_MOESM2_ESM.doc (67 kb)
Appendix Table 1Distribution of Baseline Characteristics Based on Inclusion in Study Sample (DOC 67 kb)


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Nisa M. Maruthur
    • 1
    • 2
  • Yong Ma
    • 3
  • Linda M. Delahanty
    • 4
  • Julie A. Nelson
    • 5
  • Vanita Aroda
    • 6
  • Neil H. White
    • 7
  • David Marrero
    • 8
    • 9
  • Frederick L. Brancati
    • 1
    • 2
    • 10
  • Jeanne M. Clark
    • 1
    • 2
    • 10
  • for the Diabetes Prevention Program Research Group
  1. 1.The Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreUSA
  3. 3.George Washington UniversityRockvilleUSA
  4. 4.Massachusetts General Hospital Diabetes Research Center and Harvard Medical SchoolBostonUSA
  5. 5.Southwest American Indian Center-Arizona, NIDDKPhoenixUSA
  6. 6.Department of MedicineUniversity of CaliforniaSan DiegoUSA
  7. 7.Washington University School of MedicineSt. LouisUSA
  8. 8.Regenstrief Institute for Health CareIndianapolisUSA
  9. 9.Diabetes Translational Research CenterIndiana University School of MedicineIndianapolisUSA
  10. 10.The Johns Hopkins University Bloomberg School of Public HealthBaltimoreUSA

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