Diabetes Prevention with Metformin and lifestyle programs continues over 20 years: Study
Delhi: Metformin treatment and lifestyle interventions continue to prevent type 2 diabetes (T2D) in at-risk populations, according to new data released from the Diabetes Prevention Program Outcomes Study (DPPOS). Results were based on data collected from over 2000 patients followed for an average of 22 years. Metformin is one of the most commonly used medications worldwide for the treatment of T2D.
The findings were presented at the annual 80th Scientific Sessions of the American Diabetes Association (ADA) held from June 12-16, 2020.
The DPPOS is the long-term follow-up of the Diabetes Prevention Program (DPP) -- a multi-center trial examining the ability of an intensive lifestyle or metformin to prevent or delay the development of diabetes in a high-risk population due to the presence of impaired glucose tolerance (IGT, 2-hour glucose of 140-199 mg/dl). The DPP demonstrated that lifestyle reduced diabetes onset by 58% and metformin reduced diabetes onset by 31%.
DPPOS (2002-2013) is designed to take advantage of the scientifically and clinically valuable DPP participants. This group of participants is nearly 50% minority and represents the largest at-risk population ever studied.
88% of the original 3,234 DPP participants enrolled in the DPPOS, including the DPP participants who had developed T2D and those who still had not developed diabetes. Currently, after an average of 22 years of study, 75% of the participants who enrolled in the DPP who are still alive have continued to be evaluated. The mean age of the participants is now 72 years.
Key findings include:
- Prevention effects in the original lifestyle group and metformin treatment group remain 22 years after the start of the study with a 25% and 18% reduced risk of diabetes development, respectively, compared with the original placebo group.
- The participants who did not develop diabetes had a significant (57% and 37%) lower risk of developing early changes of eye and kidney disease, respectively, and a 39% lower risk of major cardiovascular disease endpoints, such as heart attacks and stroke.
- There was no significant benefit in heart disease or the development of kidney disease or diabetic retinopathy with either of the individual interventions—metformin or the lifestyle intervention.
- Stroke and cardiovascular events were reduced in the subgroup of people who started the study before age 45, and there was a non-significant (12%) lower risk of cancer in the Metformin group compared with the placebo group.
- The intensive lifestyle intervention group also had a long-term reduction in the development of frailty.
- There was a modest increase in kidney disease with metformin, which appeared only in the oldest group of participants.
Findings from the New Data on Clinical Outcomes from the Diabetes Prevention Program Outcomes Study (DPPOS) were presented at the 80th Scientific Sessions of ADA.