Long-Term Lifestyle Program, Metformin Both Reduce Risk of Type 2 Diabetes

David Nathan, MD

The findings of a 22-year-old study indicate a continued significant reduction in the participants’ risk of developing type 2 diabetes due to an intensive lifestyle program or treatment with metformin.

The findings were published as part of the American Diabetes Association’s (ADA’s) 80th Virtual Scientific Sessions.

“The current results indicate that prevention of type 2 diabetes is possible and has important clinical benefits,” David Nathan, MD, said in a statement.

Nathan, study chair of the Diabetes Prevention Program Outcomes Study (DPPOS), and a team of investigators conducted the long-term follow-up of the Diabetes Prevention Program, which was a multi-center trial from 1996-2001. The trial established the success of either an intensive lifestyle program or treatment with metformin to prevent or delay the development of type 2 diabetes in patients who were considered high risk.

The Diabetes Prevention Program demonstrated a lifestyle intervention aimed at achieving weight loss, and metformin treatment reduced the risk of developing the condition by 58% and 31% compared to placebo after an average of 3 years. At the end of the study, 88% of the 3234 participants enrolled in the DPPOS. Investigators of the DPPOS evaluated the long-term effects of the DPP interventions on the further development of type 2 diabetes and its complications such as retinopathy, nephropathy, and cardiovascular disease.

The study has been ongoing for an average of 22 years and 75% of those who originally enrolled in the Diabetes Prevention Program are still alive and have continued to be evaluated. The participant population included those who have developed diabetes and those who have not. The results of DPPOS examined whether metformin had beneficial effects on major cardiovascular disease, including fatal and non-fatal heart attacks and stroke, or on cancer, compared with the original placebo group. The investigators also studied contributors to healthy aging and comorbidities due to the mean age of participants being 72 years old.

Overall, the team found after 22 years since the start of the study, diabetes prevention effects in the original lifestyle group and metformin treatment group still remained. There was a 25% and 18% reduced risk of diabetes development compared with the original placebo group. Among patients who did not develop diabetes, there was a significant 57% and 37% lower risk of developing early changes of eye and kidney disease and a 39% lower risk of major cardiovascular disease events.

There was no significant benefit seen with metformin or the lifestyle intervention with regard to heart disease, the development of kidney disease, or diabetic retinopathy. Still, there were positive trends with metformin in stroke reduction and for cardiovascular events among patients who started the initial study before the age of 45 years old. Metformin was also linked with a non-significant 12% lower risk of cancer compared with the placebo group.

The investigators noted the intensive lifestyle intervention group ad a long-term reduction in the development of frailty.

“The long-term benefits of the 2 (Diabetes Prevention Program) interventions on diabetes development, still present many years after they were started, are a testament to the power of these interventions and reinforce their importance in the reduction of diabetes,” Nathan concluded.

The study, "New Data on Clinical Outcomes from the Diabetes Prevention Program Outcomes Study (DPPOS)," was published as part of ADA 2020.