Differential Effects of Lifestyle Interv and Metformin for Preventing DMT2.

[Argirios Argiriou]

April 7, 2015
Differential Effects of Lifestyle Interventions and Metformin for Preventing Type 2 Diabetes
Paul S. Mueller, MD, MPH, FACP reviewing Sussman JB et al. BMJ 2015 Feb 19.

Lifestyle modification is more likely than drug therapy to prevent diabetes among patients with impaired glucose metabolism.

The American Diabetes Association recommends intensive diet intervention and physical activity counseling for people with impaired glucose tolerance or impaired fasting glucose and suggests that metformin can be considered for such patients (Diabetes Care 2015; 38:Suppl:S31). In this post hoc analysis of data from the Diabetes Prevention Program randomized trial (NEJM JW Gen Med Mar 15 2002 and N Engl J Med 2002; 346:393), researchers determined in which patients lifestyle modification or metformin therapy was most likely to prevent onset of frank diabetes.

Participants with impaired fasting glucose (95–125 mg/dL) or abnormal glucose tolerance — but not frank diabetes — were randomized to a lifestyle modification program (with weight-loss and physical-activity goals), usual care plus oral metformin therapy (850 mg twice daily), or usual care plus placebo. Of the 3060 participants, 21% developed type 2 diabetes during a median 3-year follow-up.

In this post hoc analysis, participants were stratified into quartiles according to their baseline risk for developing diabetes. Participants in the lifestyle-modification groups were less likely to develop diabetes than those in other groups: Three-year absolute risk reduction was 28% for those in the highest-risk quartile (number needed to treat [NNT], 3.5) and 5% for those in the lowest-risk quartile (NNT, 20). However, for participants in the metformin groups, only those in the highest-risk quartile benefited from drug therapy (3-year absolute risk reduction, 21%; NNT, 4.6).
Comment

This study suggests intensive diet and physical activity interventions lower risk for developing type 2 diabetes in all patients at elevated risk, whereas metformin lowers risk only for those initially at highest risk. The authors conclude their results could decrease drug overuse and could help prioritize lifestyle programs for preventing type 2 diabetes.

Editor Disclosures at Time of Publication

    Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Leadership positions in professional societies American Osler Society (Vice President)

Citation(s):

    Sussman JB et al. Improving diabetes prevention with benefit based tailored treatment: Risk based analysis of Diabetes Prevention Program. BMJ 2015 Feb 19; 350:h454. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    Abstract/FREE Full Text

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