Benefits seen in the Diabetes Prevention Program tested over longer period of time
A new study has found intensive lifestyle changes are your best bet when looking to lower the risk of developing type 2 diabetes. Over a 10-year period, a long-term study found high risk participants who lost a moderate amount of weight reduced their diabetes risk by 34 percent. The Colorado School of Public Health was one of 27 national clinical trial sites. The results appear online in The Lancet on Oct. 29.
In an earlier 3-year study called the Diabetes Prevention Program (DPP), diabetes incidence in high-risk adults was initially reduced by 58 percent with intensive lifestyle intervention. The drug metformin was also used in the first study and found some participants had a 31 percent reduction in risk, compared with a placebo. Researchers announced the findings of the DPP in 2001.
In this recent, longer-term follow-up study—called the Diabetes Prevention Program Outcomes Study (DPPOS)—the researchers looked at the persistence of the outcomes over a longer time frame. Over 10 years, the lifestyle change group saw a 34 percent reduction in type 2 diabetes risk while those treated with the oral diabetes drug reduced their rate of developing diabetes by 18 percent compared with the placebo.
“A number of years ago we knew we could decrease type 2 diabetes risk by 50 percent with lifestyle changes—we just didn’t know how long that benefit would last,” said Richard Hamman, MD, PhD, professor and dean of the Colorado School of Public Health, and vice-chair for the national study. “We now know that in those who lost weight and regained it, they still maintained a 34 percent reduction in risk for diabetes over the long term and this was true across all ethnic groups, both genders and a variety of ages. We saw the most dramatic benefits in participants over age 60, indicating the more positive the lifestyle changes are, and the longer they have to affect health, the better.”
According to a release from The Lancet, all active DPP participants (in the first study) were eligible for the follow up study. Of the 3,150 eligible participants, 2,766 (88 percent) were followed for the Diabetes Prevention Program Outcomes Study (DPPOS)—910 from the lifestyle group, 924 from the metformin group, and 932 from the placebo group. Due to the benefits of the intensive lifestyle intervention in the first study (DDP), all three groups were offered group-implemented lifestyle intervention in the second study.
“In this study, onset of diabetes was delayed by about four years by lifestyle intervention and two years by metformin compared with placebo,” according to the authors. “The long-term reductions in bodyweight and diabetes are encouraging, but further quantification of long-term outcomes is crucial to establish the benefits of diabetes prevention.”
According to the National Institutes of Health (NIH), about 11 percent of adults—24 million people—have diabetes in the United States, and up to 95 percent of them have type 2 diabetes. It is the main cause of kidney failure, limb amputations, and new onset blindness in adults and a major cause of heart disease and stroke. An additional 57 million overweight adults have glucose levels that are higher than normal but not yet in the diabetic range, a condition that substantially raises the risk of a heart attack or stroke and of developing type 2 diabetes in the next 10 years.
“The spiraling epidemics of obesity and type 2 diabetes in United States and worldwide show no signs of abating,” Griffin P. Rodgers, MD, director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health said in a release. “Millions of people could delay diabetes for years and possibly prevent the disease altogether if they lost a modest amount of weight through diet and increased physical activity.”
Intensive lifestyle changes consisted of lowering fat and calories in the diet and increasing regular physical activity to 150 minutes per week. Participants received training in diet, exercise, and behavior modification skills.
At enrollment in the DPP, participants ranged from age 25 to 85 years, with an average age of 51. Their average body mass index (BMI) was 34, which is in the obese range. Forty-five percent of participants were from minority groups disproportionately affected by type 2 diabetes: African-Americans, Hispanic/Latino Americans, American Indians, and Asian-Americans and Pacific Islanders. The trial also recruited other groups at higher risk for type 2 diabetes, including people age 60 years and older, women with a history of gestational diabetes, and people with a first-degree relative with type 2 diabetes.
According to the NIH, type 2 diabetes becomes more common with increasing age. It is strongly associated with obesity, inactivity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, and racial or ethnic background. The prevalence of diagnosed diabetes has more than doubled in the last 30 years, due in large part to the upsurge in obesity.
About the Colorado School of Public Health
The new Colorado School of Public Health is the first and only school of public health in the Rocky Mountain Region, attracting top tier faculty and students from across the country, and providing a vital contribution towards ensuring our region’s health and well-being. Collaboratively formed by the University of Colorado Denver, Colorado State University, and the University of Northern Colorado, the Colorado School of Public Health provides training, innovative research and community service to actively address public health issues, including chronic disease, access to health care, environmental threats, emerging infectious diseases, and costly injuries.
About the NIDDK
NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe and disabling conditions affecting Americans. The Institute's research interests include diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. For more information, visit www.niddk.nih.gov.
About the NIH
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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