10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes StudyDiabetes Prevention Program Research GroupThe Lancet200937497021677168610.1016/S0140-6736(09)61457-4

The Lancet (Impact Factor: 45.22). 10/2009; 374(9702):1677-86. DOI: 10.1016/S0140-6736(09)61457-4
Source: PubMed


In the 2.8 years of the Diabetes Prevention Program (DPP) randomised clinical trial, diabetes incidence in high-risk adults was reduced by 58% with intensive lifestyle intervention and by 31% with metformin, compared with placebo. We investigated the persistence of these effects in the long term.
All active DPP participants were eligible for continued follow-up. 2766 of 3150 (88%) enrolled for a median additional follow-up of 5.7 years (IQR 5.5-5.8). 910 participants were from the lifestyle, 924 from the metformin, and 932 were from the original placebo groups. On the basis of the benefits from the intensive lifestyle intervention in the DPP, all three groups were offered group-implemented lifestyle intervention. Metformin treatment was continued in the original metformin group (850 mg twice daily as tolerated), with participants unmasked to assignment, and the original lifestyle intervention group was offered additional lifestyle support. The primary outcome was development of diabetes according to American Diabetes Association criteria. Analysis was by intention-to-treat. This study is registered with, number NCT00038727.
During the 10.0-year (IQR 9.0-10.5) follow-up since randomisation to DPP, the original lifestyle group lost, then partly regained weight. The modest weight loss with metformin was maintained. Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years (95% CI 4.1-5.7) in the intensive lifestyle intervention group, 7.8 (6.8-8.8) in the metformin group, and 11.0 (9.8-12.3) in the placebo group. Diabetes incidence rates in this follow-up study were similar between treatment groups: 5.9 per 100 person-years (5.1-6.8) for lifestyle, 4.9 (4.2-5.7) for metformin, and 5.6 (4.8-6.5) for placebo. Diabetes incidence in the 10 years since DPP randomisation was reduced by 34% (24-42) in the lifestyle group and 18% (7-28) in the metformin group compared with placebo.
During follow-up after DPP, incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group, but the cumulative incidence of diabetes remained lowest in the lifestyle group. Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Download full-text


Available from: Richard Hamman, Jun 06, 2014
  • Source
    • "It may be that women who more successfully adopt lifestyle changes during pregnancy feel more motivated, self-efficacious and supported, helping them to maintain behavioural changes into postpartum. Results from the DPP trial have shown maintained weight loss to be the main predictor of risk reduction in type 2 diabetes prevention in the general population with IGT (Knowler et al., 2009). Therefore, it seems pertinent to focus on developing and testing lifestyle interventions that can produce successful long-term weight reduction among women with prior GDM. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To systematically review lifestyle interventions for women with prior Gestational Diabetes Mellitus (GDM) to report study characteristics, intervention design and study quality and explore changes in 1) diet, physical activity and sedentary behaviour; 2) anthropometric outcomes and; 3) glycaemic control and diabetes risk. Methods: Databases (Web of Science, CCRCT, EMBASE and Science DIRECT) were searched (1980 to April 2014) using keywords for controlled or pre-post design trials of lifestyle intervention targeting women with previous GDM reporting at least one behavioural, anthropometric or diabetes outcome. Selected studies were narratively synthesized with anthropometric and glycaemic outcomes synthesized using meta-analysis. Results: Three of 13 included studies were rated as low bias risk. Recruitment rates were poor but study retention good. Six of 11 studies reporting on physical activity reported favourable intervention effects. All six studies reporting on diet reported favourable intervention effects. In meta-analysis, significant weight-loss was attributable to one Chinese population study (WMD = - 1.06 kg (95% CI = -1.68, -0.44)). Lifestyle interventions did not change fasting blood glucose (WMD = -0.05. mmol/L, 95% CI = -0.21, 0.11) or type 2 diabetes risk. Conclusions: Lack of methodologically robust trials gives limited evidence for the success of lifestyle interventions in women with prior GDM. Recruitment into trials is challenging.
    Full-text · Article · May 2015
  • Source
    • "The Diabetes Prevention Program (DPP) [29] [30] and Look AHEAD trials [31] [32] [33] which both include 16 (or more) sessions have been successfully used in dissemination studies [34] [35]. The DPP trial involved 16 intensive lifestyle sessions and was successful in reducing risk for diabetes and cumulative incidence of diabetes over 10 years [29] [30]. Our intervention is consistent with these trials that have been successfully disseminated and the addition of the tailored on-line intervention expands on the DPP and Look AHEAD trials and should be relatively easy to disseminate. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Families Improving Together (FIT) randomized controlled trial tests the efficacy of integrating cultural tailoring, positive parenting, and motivational strategies into a comprehensive curriculum for weight loss in African American adolescents. The overall goal of the FIT trial is to test the effects of an integrated intervention curriculum and the added effects of a tailored web-based intervention on reducing z-BMI in overweight African American adolescents. The FIT trial is a randomized group cohort design the will involve 520 African American families with an overweight adolescent between the ages of 11-16 years. The trial tests the efficacy of an 8-week face-to-face group randomized program comparing M+FWL (Motivational Family Weight Loss) to a comprehensive health education program (CHE) and re-randomizes participants to either an 8-week on-line tailored intervention or control on-line program resulting in a 2 (M+FWL vs. CHE group) x 2 (on-line intervention vs. control on-line program) factorial design to test the effects of the intervention on reducing z-BMI at post-treatment and at 6-month follow-up. The interventions for this trial are based on a theoretical framework that is novel and integrates elements from cultural tailoring, Family Systems Theory, Self-Determination Theory and Social Cognitive Theory. The intervention targets positive parenting skills (parenting style, monitoring, communication); cultural values; teaching parents to increase youth motivation by encouraging youth to have input and choice (autonomy-support); and provides a framework for building skills and self-efficacy through developing weight loss action plans that target goal setting, monitoring, and positive feedback. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Mar 2015 · Contemporary clinical trials
  • Source
    • "Thus, exercise represents a cost-effective lifestyle intervention for disease prevention while reducing the socioeconomic burden of late-stage treatment of diabetes complications. For instance, a 10 year follow-up of intensive lifestyle modifications consisting of moderate sub-maximal exercise training lowered the incidence of diabetes by 34% in high risk adults that was about two-fold more effective than metformin therapy3. Sustained long-term benefits have also been shown to reduce diabetes progression over 13 years, where greater risk reduction was associated with adherence to lifestyle changes during the intervention period4. "
    [Show abstract] [Hide abstract]
    ABSTRACT: High-intensity interval training (HIIT) offers a practical approach for enhancing cardiorespiratory fitness, however its role in improving glucose regulation among sedentary yet normoglycemic women remains unclear. Herein, multi-segment injection capillary electrophoresis-mass spectrometry is used as a high-throughput platform in metabolomics to assess dynamic responses of overweight/obese women (BMI > 25, n = 11) to standardized oral glucose tolerance tests (OGTTs) performed before and after a 6-week HIIT intervention. Various statistical methods were used to classify plasma metabolic signatures associated with post-prandial glucose and/or training status when using a repeated measures/cross-over study design. Branched-chain/aromatic amino acids and other intermediates of urea cycle and carnitine metabolism decreased over time in plasma after oral glucose loading. Adaptive exercise-induced changes to plasma thiol redox and orthinine status were measured for trained subjects while at rest in a fasting state. A multi-linear regression model was developed to predict changes in glucose tolerance based on a panel of plasma metabolites measured for naïve subjects in their untrained state. Since treatment outcomes to physical activity are variable between-subjects, prognostic markers offer a novel approach to screen for potential negative responders while designing lifestyle modifications that maximize the salutary benefits of exercise for diabetes prevention on an individual level.
    Full-text · Article · Aug 2014 · Scientific Reports
Show more