The Diabetes Prevention Program (DPP) was a major clinical trial, or research study, prevent or delay the onset of type 2 diabetes in people with impaired …
Diabetes Prevention Program Fact Sheet
The Diabetes Prevention Program DPP was a major clinical trial, or research study, aimed at discovering whether either diet and exercise or the oral diabetes drug metformin Glucophage could prevent or delay the onset of type 2 diabetes in people with impaired glucose tolerance IGT The answer is yes In fact, the DPP found that over the 3 years of the study, diet and exercise sharply reduced the chances that a person with IGT would develop diabetes Metformin also reduced risk, although less dramatically The DPP resolved these questions so quickly that, on the advice of an external monitoring board, the program was halted a year early The researchers published their findings in the February 7, 2002, issue of the New England Journal of Medicine DPP Study Design and Goals In the DPP, participants from 27 clinical centers around the country were randomly split into different treatment groups The first group, called the lifestyle intervention group, received intensive training in diet, exercise, and behavior modification By eating less fat and fewer calories and exercising for a total of 150 minutes a week, they aimed to lose 7 percent of their body
weight and maintain that loss The second group took 850 mg of metformin twice a day The third group received placebo pills instead of metformin The metformin and placebo groups also received information on diet and exercise, but no intensive counseling efforts A fourth group was treated with the drug troglitazone Rezulin, but this part of the study was discontinued after researchers discovered that troglitazone can cause serious liver damage All 3,234 study participants were overweight and had IGT, which are well recognized risk factors for the development of type 2 diabetes In addition, 45 percent of the participants were from minority groups–African American, Hispanic American/Latino, Asian American or Pacific Islander, or American Indian–that are at increased risk of developing diabetes Type 2 Diabetes and Pre-Diabetes Diabetes is a disorder that affects the way your body uses digested food for growth and energy Normally, the food you eat is broken down into glucose The glucose then passes into your bloodstream, where it is used by your cells for growth and energy For glucose to reach your cells, however, insulin must be present Insulin is a hormone produced by your pancreas,
a hand-sized gland behind your stomach Most people with type 2 diabetes have two problems: the pancreas may not produce enough insulin, and fat, muscle, and liver cells cannot use it effectively This means that glucose builds up in the blood, overflows into the urine, and passes out of the body-without fulfilling its role as the bodys main source of fuel
About 182 million people in the United States have diabetes Of those, 13 million are diagnosed and 52 million are undiagnosed Ninety to 95 percent of people with diabetes have type 2 diabetes Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults People with diabetes are also two to four times more likely than people without diabetes to develop heart disease Pre-diabetes, also called impaired glucose tolerance IGT or impaired fasting glucose IFG, is a condition in which your blood glucose blood sugar levels are higher than normal but not high enough for a diagnosis of diabetes Having pre-diabetes puts you at higher risk for developing type 2 diabetes If you have pre-diabetes, you are also at increased risk for developing heart disease You are more likely to develop type 2 diabetes
if
you are overweight you are 45 years old or older you have a parent, brother, or sister with diabetes your family background is African American, American Indian, Asian American, Hispanic American/Latino, or Pacific Islander you have had gestational diabetes or gave birth to at least one baby weighing more than 9 pounds your blood pressure is 140/90 or higher, or you have been told that you have high blood pressure your HDL cholesterol is 35 or lower, or your triglyceride level is 250 or higher you are fairly inactive, or you exercise fewer than three times a week
In a cross-section of US adults aged 40 to 74 test 
ed during the period 1988 to 1994, 338 percent had IFG, 154 percent had IGT, and 401 percent had pre-diabetes IGT or IFG or both Applying these percentages to the 2000 US population, about 35 million adults aged 40 to 74 would have IFG, 16 million would have IGT, and 41 million would have pre-diabetes Those with pre-diabetes are likely to develop type 2 diabetes within 10 years, unless they take steps to prevent or delay diabetes The results of the Diabetes Prevention Program showed that modest weight loss and regular exercise can prevent or delay type 2
diabetes DPP Results The DPPs striking results tell us that millions of high-risk people can use diet, exercise, and behavior modification to avoid developing type 2 diabetes The DPP also suggests that metformin is effective in delaying the onset of diabetes Participants in the lifestyle intervention group–those receiving intensive counseling on effective diet, exercise, and behavior modification–reduced their risk of developing diabetes by 58 percent This finding was true across all participating ethnic groups and for both men and women Lifestyle changes worked particularly well for participants aged 60 and older, reducing their risk by 71 percent About 5 percent of the lifestyle intervention group developed diabetes each year during the study period, compared with 11 percent in those who did not get the intervention Researchers think that weight loss-2
achieved through better eating habits and exercise–reduces the risk of diabetes by improving the ability of the body to use insulin and process glucose Participants taking metformin reduced their risk of developing diabetes by 31 percent Metformin was effective for both men and women, but it was least effective in people aged
45 and older Metformin was most effective in people 25 to 44 years old and in those with a body mass index of 35 or higher at least 60 pounds overweight About 78 percent of the metformin group developed diabetes each year during the study, compared with 11 percent of the group receiving the placebo Future Research Researchers will perform other analyses to try to determine the relative contribution of diet and exercise to the reduction in diabetes The DPP was not designed to examine diet versus exercise, however, so the analyses may not provide a definitive answer Researchers will also analyze the information from the study to try to determine how lifestyle intervention and metformin affect the development of heart and blood vessel diseases, which are more common in people with pre-diabetes and type 2 diabetes The DPP did not examine whether combining lifestyle changes and metformin would further reduce the risk of developing diabetes DPP researchers plan to continue examining the roles of lifestyle and metformin in preventing type 2 diabetes They will also continue to monitor participants to learn more about the studys long-term effects The National Institute of Diabetes and
Digestive and Kidney Diseases NIDDK is encouraging new research to look at cost-effective methods of delivering lifestyle modifications in group settings and over the Internet, as well as methods to sustain behavior change and weight loss The National Diabetes Education Program NDEP–a joint project of the National Institutes of Health NIH, the Centers for Disease Control and Prevention CDC, and more than 200 public and private organizations–will disseminate the findings and protocols stemming from the DPP For more information, contact: Joanne Gallivan, MS, RD Director, NDEP National Institutes of Health 301 496-3583 Joanne_Gallivan@nihgov
Jane Kelly, MD Director, NDEP Centers for Disease Control and Prevention 770488-5196 azk9@cdcgov
HHSs National Diabetes Education Program NDEP is sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention with more than 200 public and private sector partners who work at the national, state, and local level NDEP is the leading federal education program aimed at changing the way diabetes is treated, improving the health and lives of people with diabetes, and preventing the onset of diabetes July
2004
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Source:sdchip.org
