.
MEDICAL: DISEASES: DIABETES:
A Decade Later, Lifestyle Changes or Metformin
Still Lower Type 2 Diabetes Risk
Date: Thu, 29 Oct 2009 09:20:42 -0400
From: "NIH OLIB (NIH/OD)" <[log in to unmask]>
To: [log in to unmask]
Subject: A Decade Later, Lifestyle Changes or Metformin
Still Lower Type 2 Diabetes Risk
U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH NIH News
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
<http://www.niddk.nih.gov/>
For Immediate Release: Thursday, October 29, 2009
CONTACT:
Joan Chamberlain
Mary Harris
301-496-3583
e-mail:
[log in to unmask]
A DECADE LATER, LIFESTYLE CHANGES OR METFORMIN
STILL LOWER TYPE 2 DIABETES RISK
Study reports on persistence of benefits seen in the Diabetes Prevention
Program
Intensive lifestyle changes aimed at modest weight loss reduced the rate
of developing type 2 diabetes by 34 percent compared with placebo in
people at high risk for the disease, researchers conclude based on 10
years of data.
Participants randomly assigned to make lifestyle changes also had more
favorable cardiovascular risk factors, including lower blood pressure and
triglyceride levels, despite taking fewer drugs to control their heart
disease risk, according to the study.
Treatment with the oral diabetes drug metformin reduced the rate of
developing diabetes by 18 percent after 10 years compared with placebo.
Results of the Diabetes Prevention Program Outcomes Study (DPPOS), which
examines the persistence of the interventions tested in the Diabetes
Prevention Program (DPP), appear online in The Lancet on Oct. 29, 2009.
"In 10 years, participants in the lifestyle changes group delayed type 2
diabetes by about four years compared with placebo, and those in the
metformin group delayed it by two years. The benefits of intensive
lifestyle changes were especially pronounced in the elderly. People age 60
and older lowered their rate of developing type 2 diabetes in the next 10
years by about half," said study chair David M. Nathan, M.D., of
Massachusetts General Hospital.
In the United States, about 11 percent of adults -- 24 million people --
have diabetes, and up to 95 percent of them have type 2 diabetes. An
additional 57 million overweight adults have glucose levels that are
higher than normal but not yet in the diabetic range, a condition that
substantially raises the risk of a heart attack or stroke and of
developing type 2 diabetes in the next 10 years. "The spiraling epidemics
of obesity and type 2 diabetes in United States and worldwide show no
signs of abating," said Griffin P. Rodgers, M.D., director of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of
the National Institutes of Health. "Millions of people could delay
diabetes for years and possibly prevent the disease altogether if they
lost a modest amount of weight through diet and increased physical
activity."
The DPPOS is a continuation of the DPP, a large, randomized trial in 3,234
overweight or obese adults with elevated blood glucose levels. Researchers
announced the initial findings of the DPP in 2001, a year earlier than
scheduled because results were so clear: after three years, intensive
lifestyle changes reduced the development of type 2 diabetes by 58 percent
compared with placebo. Metformin (850 milligrams twice a day) reduced it
by 31 percent compared with placebo.
Striking as the findings were, the researchers could not say how long the
benefit would endure, since the results were based on just three years of
data. After a bridge period from January to July 2002, when all
participants learned the results and were offered a 16-session program
explaining how to make intensive lifestyle changes, the DPPOS began, with
88 percent of DPP volunteers taking part.
Intensive lifestyle changes consisted of lowering fat and calories in the
diet and increasing regular physical activity to 150 minutes per week.
Participants received training in diet, exercise (most chose walking), and
behavior modification skills. In the first year of the DPP, this group
lost 15 lbs. on average but regained all but about 5 pounds over 10 years.
The metformin group has maintained a loss of about 5 pounds, and the
placebo group lost less than 2 pounds over the decade.
About 5 to 6 percent of those in the lifestyle intervention group
developed type 2 diabetes annually, an incidence rate that remained steady
throughout the DPPOS. When the DPP ended in 2001, the metformin and
placebo groups were developing diabetes at the rate of 8 and 11 percent a
year, respectively. In 10 years, however, the yearly diabetes incidence
rates for the drug and placebo groups had also fallen to about 5 to 6
percent, and the lifestyle intervention group's rate remained at this
lower level.
The researchers are looking at a number of explanations for the
convergence of diabetes incidence rates for the three groups. One may be
that lifestyle changes adopted by the drug and placebo groups after the
DPP ended may have lowered their rate of type 2 diabetes over time.
"Sustaining even modest weight loss with lifestyle changes is highly
challenging, but it produced major long-term health rewards by lowering
the risk of type 2 diabetes and reducing other cardiovascular risk factors
in people at high risk of developing diabetes," said lead author and a
principal investigator for the study, William Knowler, M.D., Dr.P.H., of
the NIDDK in Phoenix. "Once we learned how dramatically this intervention
reduced diabetes onset in the DPP, we offered modified training in
lifestyle changes to all participants, which probably contributed to the
falling diabetes rates in the placebo and metformin groups."
At enrollment in the DPP, participants ranged from age 25 to 85 years,
with an average age of 51. Their average body mass index (BMI) was 34,
which is in the obese range. BMI measures weight in relation to height.
Forty-five percent of participants were from minority groups
disproportionately affected by type 2 diabetes: African-Americans,
Hispanic/Latino Americans, American Indians, and Asian-Americans and
Pacific Islanders. The trial also recruited other groups at higher risk
for type 2 diabetes, including people age 60 years and older, women with a
history of gestational diabetes, and people with a first-degree relative
with type 2 diabetes.
Other studies have shown that diet and exercise delay type 2 diabetes in
at-risk people. However, the DPP, conducted at 27 centers nationwide
<www.bsc.gwu.edu/dpp/clinics.htmlvdoc>, was the first major trial to show
that lifestyle changes can effectively delay diabetes in a diverse
population of overweight American adults at high risk of diabetes.
Questions and Answers about the DPP/DPPOS will be available at
<http://www2.niddk.nih.gov/Research/ClinicalResearch/DPPOS>
About 24 million people in the United States have diabetes. It is the main
cause of kidney failure, limb amputations, and new onset blindness in
adults and a major cause of heart disease and stroke. Type 2 diabetes,
which accounts for up to 95 percent of all diabetes cases, becomes more
common with increasing age. It is strongly associated with obesity,
inactivity, family history of diabetes, history of gestational diabetes,
impaired glucose metabolism, and racial or ethnic background. The
prevalence of diagnosed diabetes has more than doubled in the last 30
years, due in large part to the upsurge in obesity.
The National Diabetes Education Program, jointly sponsored by the NIH, the
Centers for Disease Control and Prevention, and 200 partner organizations,
provides diabetes education to improve the treatment and outcomes for
people with diabetes, promote early diagnosis, and prevent or delay the
onset of diabetes. In its "Small Steps. Big Rewards. Prevent Type 2
Diabetes" campaign, the NDEP
<http://www.ndep.nih.gov/>
explains how people at risk can take steps to turn the tide against this
disease.
The DPP is registered as NCT00004992, and the DPPOS is registered as
NCT00038727 in clinicaltrials.gov. The studies have been funded by the
National Institute of Diabetes and Digestive and Kidney Diseases; Eunice
Kennedy Shriver National Institute of Child Health and Human Development;
National Institute on Aging; National Eye Institute; National Heart, Lung,
and Blood Institute; National Center on Minority Health and Health
Disparities; National Center for Research Resources; and Office of
Research on Women's Health within the NIH. Additional funding came from
the Indian Health Service, the Centers for Disease Control and Prevention,
and the American Diabetes Association. Lipha (Merck-Sante) provided
medication. LifeScan Inc.; Merck-Medco Managed Care, Inc.; and Merck and
Co. donated materials, equipment, or medicines.
NIDDK, part of the NIH, conducts and supports basic and clinical research
and research training on some of the most common, severe and disabling
conditions affecting Americans. The Institute's research interests include
diabetes and other endocrine and metabolic diseases; digestive diseases,
nutrition, and obesity; and kidney, urologic and hematologic diseases. For
more information, visit
<http://www.niddk.nih.gov>
The National Institutes of Health (NIH) -- The Nation's Medical Research
Agency -- includes 27 Institutes and Centers and is a component of the
U.S. Department of Health and Human Services. It is the primary federal
agency for conducting and supporting basic, clinical and translational
medical research, and it investigates the causes, treatments, and cures
for both common and rare diseases. For more information about NIH and its
programs, visit
<http://www.nih.gov>
---------------------------------
FOR BROADCAST MEDIA: A bites/b-roll package with sound bites from Dr.
David Nathan, DPP/DPPOS study chair, Dr. Griffin P. Rodgers, NIDDK
Director, and study participants will be available at
<http://multivu.prnewswire.com/broadcast/36430/press.html>
and fed via satellite as follows:
Wednesday, October 28th, 2009
1:00 PM - 1:15 PM ET
AMC 3
C-Band
Transponder 3
Downlink Freq: 3760 Horizontal
Wednesday, October 28th, 2009
6:30 PM - 6:45 PM ET
Galaxy 19
C-Band
Transponder 8
Downlink Freq: 3860 Horizontal
For general questions regarding the newsfeed,
contact MultiVu's Media Relations Office at 800-653-5313 x3.
##
This NIH News Release is available online at:
<http://www.nih.gov/news/health/oct2009/niddk-29.htm>
Sincerely,
David Dillard
Temple University
(215) 204 - 4584
[log in to unmask]
<http://daviddillard.businesscard2.com>
Net-Gold
<http://groups.yahoo.com/group/net-gold>
Index: <http://tinyurl.com/myxb4w>
<http://listserv.temple.edu/archives/net-gold.html>
<http://groups.google.com/group/net-gold?hl=en>
<http://net-gold.jiglu.com/>
General Internet & Print Resources
<http://guides.temple.edu/general-internet>
COUNTRIES
<http://guides.temple.edu/general-country-info>
EMPLOYMENT
<http://guides.temple.edu/EMPLOYMENT>
TOURISM
<http://guides.temple.edu/tourism>
DISABILITIES
http://guides.temple.edu/DISABILITIES
INDOOR GARDENING
<http://tech.groups.yahoo.com/group/IndoorGardeningUrban/>
Educator-Gold
<http://groups.yahoo.com/group/Educator-Gold/>
K12ADMINLIFE
<http://groups.yahoo.com/group/K12AdminLIFE/>
RUSSELL CONWELL CENTER SUBJECT GUIDE
http://guides.temple.edu/Russell-Conwell-Center
THE COLLEGE LEARNING CENTER
<http://tinyurl.com/yae7w79>
Nina Dillard's Photographs on Net-Gold
<http://tinyurl.com/36qd2o>
Net-Gold Membership Required to View Photos
Twitter: davidpdillard
Bushell, R. & Sheldon, P. (eds),
Wellness and Tourism: Mind, Body, Spirit,
Place, New York: Cognizant Communication Books.
Wellness Tourism: Bibliographic and Webliographic Essay
David P. Dillard
<http://tinyurl.com/p63whl>
<http://tinyurl.com/ou53aw>
INDOOR GARDENING
Improve Your Chances for Indoor Gardening Success
http://tech.groups.yahoo.com/group/IndoorGardeningUrban/
http://groups.google.com/group/indoor-gardening-and-urban-gardening
http://indoorgardening.jiglu.com/
SPORT-MED
https://www.jiscmail.ac.uk/lists/sport-med.html
http://sportmed.jiglu.com/
http://groups.google.com/group/sport-med
http://groups.yahoo.com/group/sports-med/
http://listserv.temple.edu/archives/sport-med.html
Health Diet Fitness Recreation Sports Tourism
http://health.groups.yahoo.com/group/healthrecsport/
http://groups.google.com/group/healthrecsport
http://healthrecsport.jiglu.com/
[log in to unmask]
.
|
