Early Response to Preventive Strategies in the Diabetes Prevention Program
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The Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA; 3George Washington University, Rockville, MD, USA; 4Massachusetts General Hospital Diabetes Research Center and Harvard Medical School, Boston, MA, USA; 5Southwest American Indian Center-Arizona, NIDDK, Phoenix, AZ, USA; 6Department of Medicine, University of California, San Diego, CA, USA; 7Washington University School of Medicine, St. Louis, MO, USA; 8Regenstrief Institute for Health Care, Indianapolis, IN, USA; 9Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN, USA; 10The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
BACKGROUND: Recommendations for diabetes prevention in patients with prediabetes include lifestyle modification and metformin. However, the significance of early weight loss and glucose measurements when monitoring response to these proven interventions is unknown. OBJECTIVE: To quantify the relationship between early measures of weight and glucose and subsequent diabetes in patients undergoing diabetes prevention interventions. DESIGN: Analysis of results from a randomized controlled trial in 27 academic medical centers in the United States. PARTICIPANTS/INTERVENTIONS: 3,041 adults with hyperglycemia randomized to lifestyle (n=1,018), metformin (n=1,036), or placebo (n=987) with complete follow-up in The Diabetes Prevention Program. MAIN MEASURES: Independent variables were weight loss at 6 and 12 months; fasting glucose (FG) at 6 months; hemoglobin A1c (HbA1c) at 6 months; and post-load glucose at 12 months. The main outcome was time to diabetes diagnosis. KEY RESULTS: After 6 months, 604 participants developed diabetes in the lifestyle (n=140), metformin (n=206), and placebo (n=258) arms over 2.7 years. In the lifestyle arm, 6-month weight loss predicted decreased diabetes risk in a graded fashion: adjusted HR (95 % CI) 0.65 (0.35– 1.22), 0.62 (0.33–1.18), 0.46 (0.24–0.87), 0.34 (0.18– 0.64), and 0.15 (0.07–0.30) for 0–
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