Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: The Diabetes Prevention Program Outcomes Study

Diabetes Prevention Program Research Group

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208 Citations (Scopus)

Abstract

Background: Effective prevention is needed to combat the worldwide epidemic of type 2 diabetes. We investigated the long-term extent of beneficial effects of lifestyle intervention and metformin on diabetes prevention, originally shown during the 3-year Diabetes Prevention Program (DPP), and assessed whether these interventions reduced diabetes-associated microvascular complications. Methods: The DPP (1996-2001) was a randomised trial comparing an intensive lifestyle intervention or masked metformin with placebo in a cohort selected to be at very high risk of developing diabetes. All participants were offered lifestyle training at the end of the DPP. 2776 (88%) of the surviving DPP cohort were followed up in the DPP Outcomes Study (DPPOS, Sept 1, 2002, to Jan 2, 2014) and analysed by intention to treat on the basis of their original DPP assignment. During DPPOS, the original lifestyle intervention group was offered lifestyle reinforcement semi-annually and the metformin group received unmasked metformin. The primary outcomes were the development of diabetes and the prevalence of microvascular disease. For the assessment of microvascular disease, we used an aggregate microvascular outcome, composed of nephropathy, retinopathy, and neuropathy. Findings: During a mean follow-up of 15 years, diabetes incidence was reduced by 27% in the lifestyle intervention group (hazard ratio 0·73, 95% CI 0·65-0·83; p

Original languageEnglish (US)
Pages (from-to)866-875
Number of pages10
JournalThe Lancet Diabetes and Endocrinology
Volume3
Issue number11
DOIs
StatePublished - Nov 1 2015

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Metformin
Life Style
Outcome Assessment (Health Care)
Type 2 Diabetes Mellitus
Placebos
Incidence

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Endocrinology

Cite this

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title = "Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: The Diabetes Prevention Program Outcomes Study",
abstract = "Background: Effective prevention is needed to combat the worldwide epidemic of type 2 diabetes. We investigated the long-term extent of beneficial effects of lifestyle intervention and metformin on diabetes prevention, originally shown during the 3-year Diabetes Prevention Program (DPP), and assessed whether these interventions reduced diabetes-associated microvascular complications. Methods: The DPP (1996-2001) was a randomised trial comparing an intensive lifestyle intervention or masked metformin with placebo in a cohort selected to be at very high risk of developing diabetes. All participants were offered lifestyle training at the end of the DPP. 2776 (88{\%}) of the surviving DPP cohort were followed up in the DPP Outcomes Study (DPPOS, Sept 1, 2002, to Jan 2, 2014) and analysed by intention to treat on the basis of their original DPP assignment. During DPPOS, the original lifestyle intervention group was offered lifestyle reinforcement semi-annually and the metformin group received unmasked metformin. The primary outcomes were the development of diabetes and the prevalence of microvascular disease. For the assessment of microvascular disease, we used an aggregate microvascular outcome, composed of nephropathy, retinopathy, and neuropathy. Findings: During a mean follow-up of 15 years, diabetes incidence was reduced by 27{\%} in the lifestyle intervention group (hazard ratio 0·73, 95{\%} CI 0·65-0·83; p",
author = "{Diabetes Prevention Program Research Group} and Nathan, {David M.} and Elizabeth Barrett-Connor and Crandall, {Jill P.} and Edelstein, {Sharon L.} and Goldberg, {Ronald B.} and Horton, {Edward S.} and Knowler, {William C.} and Kieren Mather and Orchard, {Trevor J.} and Xavier Pi-Sunyer and David Schade and Marinella Temprosa",
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T1 - Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up

T2 - The Diabetes Prevention Program Outcomes Study

AU - Diabetes Prevention Program Research Group

AU - Nathan, David M.

AU - Barrett-Connor, Elizabeth

AU - Crandall, Jill P.

AU - Edelstein, Sharon L.

AU - Goldberg, Ronald B.

AU - Horton, Edward S.

AU - Knowler, William C.

AU - Mather, Kieren

AU - Orchard, Trevor J.

AU - Pi-Sunyer, Xavier

AU - Schade, David

AU - Temprosa, Marinella

PY - 2015/11/1

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N2 - Background: Effective prevention is needed to combat the worldwide epidemic of type 2 diabetes. We investigated the long-term extent of beneficial effects of lifestyle intervention and metformin on diabetes prevention, originally shown during the 3-year Diabetes Prevention Program (DPP), and assessed whether these interventions reduced diabetes-associated microvascular complications. Methods: The DPP (1996-2001) was a randomised trial comparing an intensive lifestyle intervention or masked metformin with placebo in a cohort selected to be at very high risk of developing diabetes. All participants were offered lifestyle training at the end of the DPP. 2776 (88%) of the surviving DPP cohort were followed up in the DPP Outcomes Study (DPPOS, Sept 1, 2002, to Jan 2, 2014) and analysed by intention to treat on the basis of their original DPP assignment. During DPPOS, the original lifestyle intervention group was offered lifestyle reinforcement semi-annually and the metformin group received unmasked metformin. The primary outcomes were the development of diabetes and the prevalence of microvascular disease. For the assessment of microvascular disease, we used an aggregate microvascular outcome, composed of nephropathy, retinopathy, and neuropathy. Findings: During a mean follow-up of 15 years, diabetes incidence was reduced by 27% in the lifestyle intervention group (hazard ratio 0·73, 95% CI 0·65-0·83; p

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