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: 3.12). 07/2012; 30(1). DOI: 10.1111/j.1464-5491.2012.03750.x
Source: PubMed


Diabet. Med. 30, 46–55 (2013)
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 to −3) and diastolic (−6 to −6.5 mmHg) blood pressure, and for LDL cholesterol (−0.51 to −0.6 mmol/l) and triglycerides (−0.23 to −0.25 mmol/l) in all groups, with no between-group differences. HDL cholesterol also rose significantly (0.14 to 0.15 mmol/l) in all groups. Lipid (P = 0.01) 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.

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    • "The original DPP-LI was developed using the social cognitive theory (SCT) [36] by nutritionists, behavioral psychologists, exercise physiologists, nurses, and physicians from the University of Pittsburgh Medical Center and the DPP Interventions Committee [37, 38]. Nine of the 16 behavior change technique clusters as defined by Michie et al. [39] were used repeatedly in the DPP-LI curriculum, including: reward (e.g., self-reward), antecedents (e.g., avoidance and changing exposure to cues for the behavior), associations (e.g., prompts/cues), natural consequences (e.g., social consequences), feedback and monitoring (e.g., self-monitoring of behavior), goals and planning (e.g., goal setting — outcome), social support (e.g., social support — general), self-belief (e.g., self-talk), and shaping knowledge (e.g., instructions on how to perform a behavior). "
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    ABSTRACT: Native Hawaiians/Pacific Islanders experience a high prevalence of overweight/obesity. The Diabetes Prevention Program Lifestyle Intervention (DPP-LI) was translated into a 3-month community-based intervention to benefit these populations. The weight loss and other clinical and behavioral outcomes of the translated DPP-LI and the socio-demographic, behavioral, and biological factors associated with the weight loss were examined. A total of 239 Native Hawaiian/Pacific Islander adults completed the translated DPP-LI through four community-based organizations (CBOs). Changes from pre- to postintervention assessments in weight, blood pressure, physical functioning, exercise frequency, and fat in diet were measured. Significant improvements on all variables were found, with differences observed across the four CBOs. CBOs with predominately Native Hawaiian and ethnically homogenous intervention groups had greater weight loss. General linear modeling indicated that larger baseline weight and CBO predicted weight loss. The translated DPP-LI can be effective for Native Hawaiians/Pacific Islanders, especially when socio-cultural, socioeconomic, and CBO-related contextual factors are taken into account.
    Translational Behavioral Medicine 12/2013; DOI:10.1007/s13142-013-0244-x
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    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 · 6.00 Impact Factor
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    ABSTRACT: Objectives: 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. Methods: A total of 1,010 first-degree relatives of consecutive patients with type 2 diabetes, 30-70 years old (274 men and 736 women), without diabetes and MetS, were examined and followed up over 8.0 ± 1.6 years (mean ± SD) for MetS incidence. The incidence of MetS was examined across quartiles of FINDRISC, and a receiver operating characteristic (ROC) curve was plotted to assess the discrimination. At baseline and through follow-ups, participants underwent a standard 75 g 2-hour oral glucose tolerance test (OGTT). Data for determining FINDRISC were available from each participant. Results: During 8,089 person-years of follow-up, 69 men and 209 women without MetS and diabetes at baseline subsequently developed MetS. The incidence of MetS was 31.4 per 1000 person-years in men and 35.5 in women. The FINDRSC at baseline was significantly associated with MetS evolution. Participants in the top quartile of FINDRISC were 4.4 times more likely to develop MetS than those in the bottom quartile (rate ratio 4.4; 95% CI 2.7-7.0). The area under the ROC curve was 65.0% (95% CI 61.3-68.7). Conclusion: The results of this study suggest that FINDRISC can be applied to detect MetS in a high-risk population.
    The Review of Diabetic Studies 01/2013; 10(4):283-92. DOI:10.1900/RDS.2013.10.283
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