Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: A report from the DPP Outcomes Study

Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA The Biostatistics Center, George Washington University, Rockville, MD Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA Division of Endocrinology, Diabetes and Metabolism, University of Miami Miller School of Medicine, Miami, FL Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, IN Northwest Lipid Research Labs, University of Washington, Seattle, WA University of Texas Health Sciences Center at San Antonio, San Antonio, TX Medstar Health Research Institute The Johns Hopkins School of Medicine, Baltimore, MD and Los Angeles Diabetes Center, University of California Los Angeles, Alhambra, CA, USA.
Diabetic Medicine (Impact Factor: 3.06). 07/2012; 30(1). DOI: 10.1111/j.1464-5491.2012.03750.x
Source: PubMed

ABSTRACT Aims  Whether long-term cardiovascular risk is reduced by the Diabetes Prevention Program interventions is unknown. The aim of this study was to determine the long-term differences in cardiovascular disease risk factors and the use of lipid and blood pressure medications by the original Diabetes Prevention Program intervention group. Methods  This long-term follow-up (median 10 years, interquartile range 9.0-10.5) of the three-arm Diabetes Prevention Program randomized controlled clinical trial (metformin, intensive lifestyle and placebo), performed on 2766 (88%) of the Diabetes Prevention Program participants (who originally had impaired glucose tolerance), comprised a mean of 3.2 years of randomized treatment, approximately 1-year transition (during which all participants were offered intensive lifestyle intervention) and 5 years follow-up (Diabetes Prevention Program Outcomes Study). During the study, participants were followed in their original groups with their clinical care being provided by practitioners outside the research setting. The study determined lipoprotein profiles and blood pressure and medication use annually. Results  After 10 years' follow-up from Diabetes Prevention Program baseline, major reductions were seen for systolic (2-3 mmHg) and diastolic (5-6 mmHg) blood pressure, and for LDL cholesterol (0.47-0.54 mmol/l) and triglycerides (0.18-0.32 mmol/l) in all groups, with no between-group differences. HDL cholesterol also rose significantly (0.13-0.16 mmol/l) in all groups. Lipid (P < 0.012) and blood pressure (P < 0.09) medication use, however, were lower for the lifestyle group during the Diabetes Prevention Program Outcomes Study. Conclusion  Overall, intensive lifestyle intervention achieved, with less medication, a comparable long-term effect on cardiovascular disease risk factors, to that seen in the metformin and placebo groups. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: This review describes the effect of lifestyle change or metformin compared with standard care on incident type 2 diabetes and cardiometabolic risk factors in the Diabetes Prevention Program and its Outcome Study. The Diabetes Prevention Program was a randomized controlled clinical trial of intensive lifestyle and metformin treatments versus standard care in 3234 subjects at high risk for type 2 diabetes. At baseline, hypertension was present in 28% of subjects, and 53% had metabolic syndrome with considerable variation in risk factors by age, sex, and race. Over 2.8 years, type 2 diabetes incidence fell by 58% and 31% in the lifestyle and metformin groups, respectively, and metabolic syndrome prevalence fell by one-third with lifestyle change but was not reduced by metformin. In placebo- and metformin-treated subjects, the prevalence of hypertension and dyslipidemia increased during the Diabetes Prevention Program, whereas lifestyle intervention slowed these increases significantly. During long-term follow-up using modified interventions, type 2 diabetes incidence decreased to ≈5% per year in all groups. This was accompanied by significant improvement in cardiovascular disease risk factors over time in all treatment groups, in part associated with increasing use of lipid-lowering and antihypertensive medications. Thus a program of lifestyle change significantly reduced type 2 diabetes incidence and metabolic syndrome prevalence in subjects at high risk for type 2 diabetes. Metformin had more modest effects.
    Arteriosclerosis Thrombosis and Vascular Biology 09/2012; 32(9):2077-90. DOI:10.1161/ATVBAHA.111.241893 · 5.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obesity is a polygenic chronic condition, and dysregulation in multiple underlying energy balance processes drives the obese phenotype. Lifestyle changes can be difficult to sustain long term, and anti-obesity drugs can be an advantageous component of a successful weight loss plan. However, due to lack of efficacy or adverse safety profiles, there is currently a limited selection of anti-obesity drugs on the market. This, coupled with the notable interindividual variability in efficacy of approved treatments, represents a significant unmet medical need. In this review, we will highlight this variability in weight loss response to these existing anti-obesity compounds and discuss how underpinning genetic variation is associated with weight loss outcomes. Existing research in the field of pharmacogenomics and obesity drugs will be highlighted, as will possibilities for future focus. We will conclude by exploring examples of successful pharmacogenomics studies, and also by asking how pharmacogenomics can be built into the drug development pipeline for the benefit of patients and pharmaceutical companies alike. © 2013 S. Karger AG, Basel.
    Human Heredity 01/2013; 75(2-4):116-126. DOI:10.1159/000349975 · 1.64 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Traditionally, the Finnish Diabetes Risk Score (FINDRISC) questionnaire is a screening tool to estimate risk of type 2 diabetes. In this study, we evaluated the ability of FINDRISC to predict the development of the metabolic syndrome (MetS) in an Iranian population without diabetes and MetS.
    The Review of Diabetic Studies 01/2013; 10(4):283-92. DOI:10.1900/RDS.2013.10.283
Show more