Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study - PubMed (original) (raw)
Randomized Controlled Trial
doi: 10.1111/j.1464-5491.2012.03750.x.
T J Orchard, M Temprosa, E Barrett-Connor, S E Fowler, R B Goldberg, K J Mather, S M Marcovina, M Montez, R E Ratner, C D Saudek, H Sherif, K E Watson
Collaborators, Affiliations
- PMID: 22812594
- PMCID: PMC3524372
- DOI: 10.1111/j.1464-5491.2012.03750.x
Randomized Controlled Trial
Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study
Diabetes Prevention Program Outcomes Study Research Group et al. Diabet Med. 2013 Jan.
Abstract
Aims: Whether long-term cardiovascular risk is reduced by the Diabetes Prevention Program interventions is unknown. The aim of this study was to determine the long-term differences in cardiovascular disease risk factors and the use of lipid and blood pressure medications by the original Diabetes Prevention Program intervention group.
Methods: This long-term follow-up (median 10 years, interquartile range 9.0-10.5) of the three-arm Diabetes Prevention Program randomized controlled clinical trial (metformin, intensive lifestyle and placebo), performed on 2766 (88%) of the Diabetes Prevention Program participants (who originally had impaired glucose tolerance), comprised a mean of 3.2 years of randomized treatment, approximately 1-year transition (during which all participants were offered intensive lifestyle intervention) and 5 years follow-up (Diabetes Prevention Program Outcomes Study). During the study, participants were followed in their original groups with their clinical care being provided by practitioners outside the research setting. The study determined lipoprotein profiles and blood pressure and medication use annually.
Results: After 10 years' follow-up from Diabetes Prevention Program baseline, major reductions were seen for systolic (-2 to -3) and diastolic (-6 to -6.5 mmHg) blood pressure, and for LDL cholesterol (-0.51 to -0.6 mmol/l) and triglycerides (-0.23 to -0.25 mmol/l) in all groups, with no between-group differences. HDL cholesterol also rose significantly (0.14 to 0.15 mmol/l) in all groups. Lipid (P = 0.01) and blood pressure (P = 0.09) medication use, however, were lower for the lifestyle group during the Diabetes Prevention Program Outcomes Study.
Conclusion: Overall, intensive lifestyle intervention achieved, with less medication, a comparable long-term effect on cardiovascular disease risk factors, to that seen in the metformin and placebo groups.
Trial registration: ClinicalTrials.gov NCT00038727.
© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
Conflict of interest statement
Competing interests
TJO has been a consultant for Astra Zeneca. RG has speaker honoraria from Merck, GSK and Daiichi-Sankoyo; research grants from Abbott, GSK and Roche; and is on the Consultant Board of GSK, Daiichi-Sankoyo and Pfizer. MT, EB-C, SF, KM, SM, MM, RR, CS, HS and KW have nothing to declare.
Figures
Figure 1
Changes in cardiovascular disease risk factors from baseline by treatment group. Mean changes from baseline are adjusted for baseline level. For triglyceride changes, the means are calculated in the log scale and changes are calculated as (per cent change − 1) × mean at baseline. Data presented are based on number of participants with annual visits, which include: year 1 = 2711, year 2 = 2717, year 3 = 2698, year 4 = 2635, year 5 = 2584, year 6 = 2552, year 7 = 2519, year 8 = 2518, year 9 = 2473, year 10 = 1636.
Figure 2
Per cent change in (a) HDL cholesterol, (b) LDL cholesterol and (c) triglycerides by treatment group and statin use at visit. Per cent changes in mean (95% CI) are adjusted for baseline levels. The numbers represent participants included for the year and statin status. Statin status is based on reported concomitant medications at current year.
Figure 3
Proportion of each treatment group meeting guideline criteria by diabetes status at each visit. Data presented are percentage meeting guideline with 95% CI. The numbers represent participants included for the year and diabetes status. Diabetes status is current status for the year. Hypertension was defined as use of anti-hypertensive medications or systolic/diastolic blood pressure ≥ 140/90 for participants without diabetes or systolic/diastolic blood pressure ≥ 130/80 with diabetes. Dyslipidaemia is meeting any of the three criteria: triglyceride ≥ 1.7 mmol/l, LDL cholesterol ≥ 2.6 mmol/l or use of lipid-lowering medications.
Similar articles
- Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study.
Diabetes Prevention Program Research Group. Diabetes Prevention Program Research Group. Lancet Diabetes Endocrinol. 2015 Nov;3(11):866-75. doi: 10.1016/S2213-8587(15)00291-0. Epub 2015 Sep 13. Lancet Diabetes Endocrinol. 2015. PMID: 26377054 Free PMC article. Clinical Trial. - 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.
Diabetes Prevention Program Research Group; Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. Diabetes Prevention Program Research Group, et al. Lancet. 2009 Nov 14;374(9702):1677-86. doi: 10.1016/S0140-6736(09)61457-4. Epub 2009 Oct 29. Lancet. 2009. PMID: 19878986 Free PMC article. Clinical Trial. - A primary care register for impaired glucose handling (IGH): impact on cardiometabolic profile.
Heald AH, Knapman H, Nair S, Chambers T, Radford D, Rushton T, Anderson SG. Heald AH, et al. Prim Care Diabetes. 2012 Oct;6(3):213-9. doi: 10.1016/j.pcd.2012.02.002. Epub 2012 May 4. Prim Care Diabetes. 2012. PMID: 22560663 - Targeting the consequences of the metabolic syndrome in the Diabetes Prevention Program.
Goldberg RB, Mather K. Goldberg RB, et al. Arterioscler Thromb Vasc Biol. 2012 Sep;32(9):2077-90. doi: 10.1161/ATVBAHA.111.241893. Arterioscler Thromb Vasc Biol. 2012. PMID: 22895669 Free PMC article. Review. - Metformin for diabetes prevention: insights gained from the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study.
Aroda VR, Knowler WC, Crandall JP, Perreault L, Edelstein SL, Jeffries SL, Molitch ME, Pi-Sunyer X, Darwin C, Heckman-Stoddard BM, Temprosa M, Kahn SE, Nathan DM; Diabetes Prevention Program Research Group. Aroda VR, et al. Diabetologia. 2017 Sep;60(9):1601-1611. doi: 10.1007/s00125-017-4361-9. Epub 2017 Aug 2. Diabetologia. 2017. PMID: 28770322 Free PMC article. Review.
Cited by
- Development and validation of nomograms for predicting cardiovascular disease risk in patients with prediabetes and diabetes.
Li Z, Kang S, Kang H. Li Z, et al. Sci Rep. 2024 Sep 8;14(1):20909. doi: 10.1038/s41598-024-71904-3. Sci Rep. 2024. PMID: 39245747 Free PMC article. - Semaglutide and Cardiovascular Outcomes by Baseline HbA1c and Change in HbA1c in People With Overweight or Obesity but Without Diabetes in SELECT.
Lingvay I, Deanfield J, Kahn SE, Weeke PE, Toplak H, Scirica BM, Rydén L, Rathor N, Plutzky J, Morales C, Lincoff AM, Lehrke M, Jeppesen OK, Gajos G, Colhoun HM, Cariou B, Ryan D; SELECT Trial Investigators. Lingvay I, et al. Diabetes Care. 2024 Aug 1;47(8):1360-1369. doi: 10.2337/dc24-0764. Diabetes Care. 2024. PMID: 38907684 Free PMC article. Clinical Trial. - American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care.
Grega ML, Shalz JT, Rosenfeld RM, Bidwell JH, Bonnet JP, Bowman D, Brown ML, Dwivedi ME, Ezinwa NM, Kelly JH, Mechley AR, Miller LA, Misquitta RK, Parkinson MD, Patel D, Patel PM, Studer KR, Karlsen MC. Grega ML, et al. Am J Lifestyle Med. 2023 Oct 25;18(2):269-293. doi: 10.1177/15598276231202970. eCollection 2024 Mar-Apr. Am J Lifestyle Med. 2023. PMID: 38559790 - Prevalence of Distal Symmetrical Polyneuropathy by Diabetes Prevention Program Treatment Group, Diabetes Status, Duration of Diabetes, and Cumulative Glycemic Exposure.
Lee CG, Ciarleglio A, Edelstein SL, Crandall JP, Dabelea D, Goldberg RB, Kahn SE, Knowler WC, Ma MT, White NH, Herman WH; Diabetes Prevention Program Research Group. Lee CG, et al. Diabetes Care. 2024 May 1;47(5):810-817. doi: 10.2337/dc23-2009. Diabetes Care. 2024. PMID: 38502874 Clinical Trial. - Remission of type 2 diabetes: always more questions, but enough answers for action.
Rothberg A, Lean M, Laferrère B. Rothberg A, et al. Diabetologia. 2024 Apr;67(4):602-610. doi: 10.1007/s00125-023-06069-1. Epub 2024 Jan 8. Diabetologia. 2024. PMID: 38189935 Free PMC article. Review.
References
- Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Coronary heart disease risk and impaired glucose tolerance: the Whitehall Study. Lancet. 1980;8183:1373–1376. - PubMed
- Pan X-R, Li G-W, Hu Y-H, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20:537–544. - PubMed
- Tuomilehto J, Lindström J, Eriksson JG, et al. for the Finnish Diabetes Prevention Study Group. N Engl J Med. 2001;344:1343–1350. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
- U01 DK048406/DK/NIDDK NIH HHS/United States
- U01 DK048489/DK/NIDDK NIH HHS/United States
- P30 DK017047/DK/NIDDK NIH HHS/United States
- P30 DK079637/DK/NIDDK NIH HHS/United States
- P30 DK072476/DK/NIDDK NIH HHS/United States
LinkOut - more resources
Full Text Sources
Medical