Relationship of body size and shape to the development of diabetes in the diabetes prevention program - PubMed (original) (raw)

Randomized Controlled Trial

. 2006 Nov;14(11):2107-17.

doi: 10.1038/oby.2006.246.

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Randomized Controlled Trial

Relationship of body size and shape to the development of diabetes in the diabetes prevention program

Diabetes Prevention Program Research Group. Obesity (Silver Spring). 2006 Nov.

Abstract

Objective: We report the effects of several different measures of body size at baseline on the subsequent development of diabetes. High levels of body fat predict the onset of diabetes, but this association has not been previously reported in a large multiethnic population of overweight or obese people with impaired glucose tolerance.

Research methods and procedures: Height, weight, waist circumference, hip circumference, and skinfolds were measured at baseline in 3234 participants enrolled in a randomized clinical trial to treat individuals with impaired glucose tolerance with placebo, metformin, or a lifestyle modification program. Cox proportional hazards models were used to assess the effect of baseline body size variables on the development of diabetes.

Results: Over an average of 3.2 years in both the placebo and lifestyle groups, baseline waist circumference had the highest or second highest R(2) value for predicting diabetes in both sexes. Cox hazard ratios per 1 standard deviation were 1.43 and 1.49 for men in the placebo or lifestyle groups, respectively, and 1.29 and 1.53 for women in the placebo and lifestyle groups, respectively, adjusted for age and self-reported race/ethnicity. The c-statistic from the receiver operating characteristic curves also favored the waist circumference in men and women in the lifestyle group and men in the placebo group. No components of body size were predictive in the metformin-treated group, and metformin compared with the placebo group was effective in preventing diabetes only in individuals with a BMI > or =35 kg/m(2) or a waist circumference > or =98.0 cm.

Discussion: Large waist circumference was a better predictor of risk for developing diabetes than most other measures in the placebo and lifestyle groups. No baseline measure of body size or shape predicted risk of diabetes in the metformin-treated group.

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Figures

Figure 1

Figure 1

Incidence of diabetes by waist circumference and treatment group in men (A) and women (B). Lifestyle lowered the incidence of diabetes similarly in all three tertiles of waist circumference. The incidence of diabetes was similar with metformin at all three levels of waist circumference. In men, the largest effect, relative to placebo, was seen in the group with the largest waist circumferences. In women, in those with the largest waist circumference, the effect of metformin was similar to that of lifestyle on the incidence of diabetes.

Figure 2

Figure 2

Incidence of diabetes by BMI and treatment group in men (A) and women (B). Lifestyle lowered the incidence rate at all three levels of BMI relative to placebo. In men, metformin was most effective in the highest BMI group, where the effect was similar to that of lifestyle. In women, metformin was effective only in the highest BMI group, where the effect was similar to that of lifestyle.

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