Targeting the consequences of the metabolic syndrome in the diabetes prevention program

Ronald B. Goldberg, Kieren Mather

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

This review describes the effect of lifestyle change or metformin compared with standard care on incident type 2 diabetes and cardiometabolic risk factors in the Diabetes Prevention Program and its Outcome Study. The Diabetes Prevention Program was a randomized controlled clinical trial of intensive lifestyle and metformin treatments versus standard care in 3234 subjects at high risk for type 2 diabetes. At baseline, hypertension was present in 28% of subjects, and 53% had metabolic syndrome with considerable variation in risk factors by age, sex, and race. Over 2.8 years, type 2 diabetes incidence fell by 58% and 31% in the lifestyle and metformin groups, respectively, and metabolic syndrome prevalence fell by one-third with lifestyle change but was not reduced by metformin. In placebo-and metformin-treated subjects, the prevalence of hypertension and dyslipidemia increased during the Diabetes Prevention Program, whereas lifestyle intervention slowed these increases significantly. During long-term follow-up using modified interventions, type 2 diabetes incidence decreased to ∼5% per year in all groups. This was accompanied by significant improvement in cardiovascular disease risk factors over time in all treatment groups, in part associated with increasing use of lipid-lowering and antihypertensive medications. Thus a program of lifestyle change significantly reduced type 2 diabetes incidence and metabolic syndrome prevalence in subjects at high risk for type 2 diabetes. Metformin had more modest effects.

Original languageEnglish (US)
Pages (from-to)2077-2090
Number of pages14
JournalArteriosclerosis, Thrombosis, and Vascular Biology
Volume32
Issue number9
DOIs
StatePublished - Sep 2012

Keywords

  • lifestyle
  • metabolic syndrome
  • metformin
  • prediabetes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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