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Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

Abstract

BACKGROUND

Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes.

METHODS

We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups.

RESULTS

The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.

CONCLUSIONS

Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.

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  • Authors+Show Affiliations

    ,

    Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA.

    , , , , , ,

    Source

    The New England journal of medicine 346:6 2002 Feb 07 pg 393-403

    MeSH

    Adult
    Blood Glucose
    Body Mass Index
    Diabetes Mellitus, Type 2
    Double-Blind Method
    Energy Intake
    Exercise
    Female
    Humans
    Hypoglycemic Agents
    Incidence
    Life Style
    Male
    Metformin
    Middle Aged
    Patient Compliance
    Risk Factors
    Weight Loss

    Pub Type(s)

    Clinical Trial
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    11832527

    Citation

    Knowler, William C., et al. "Reduction in the Incidence of Type 2 Diabetes With Lifestyle Intervention or Metformin." The New England Journal of Medicine, vol. 346, no. 6, 2002, pp. 393-403.
    Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
    Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., Walker, E. A., & Nathan, D. M. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine, 346(6), pp. 393-403.
    Knowler WC, et al. Reduction in the Incidence of Type 2 Diabetes With Lifestyle Intervention or Metformin. N Engl J Med. 2002 Feb 7;346(6):393-403. PubMed PMID: 11832527.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. AU - Knowler,William C, AU - Barrett-Connor,Elizabeth, AU - Fowler,Sarah E, AU - Hamman,Richard F, AU - Lachin,John M, AU - Walker,Elizabeth A, AU - Nathan,David M, AU - ,, PY - 2002/2/8/pubmed PY - 2002/2/21/medline PY - 2002/2/8/entrez SP - 393 EP - 403 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 346 IS - 6 N2 - BACKGROUND: Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. METHODS: We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. RESULTS: The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. CONCLUSIONS: Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/11832527/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa012512?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -