The Diabetes Prevention Program (DPP) was a major clinical trial, or research study, the onset of type 2 diabetes in people. with impaired glucose …
Diabetes Prevention Program
National Diabetes Information Clearinghouse
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 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
National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH
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
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 handsized 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,
US Department of Health and Human Services
overflows into the urine, and passes out of the body–without fulfilling its role as the bodys main source of fuel About 208 million people in the United States have diabetes Of those, 146 million are diagnosed and 62 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 Pre-diabetes is becoming more common in the United States, according to new estimates provided by the US Department of Health and Human Services About 40 percent of US adults ages 40 to 74–or 41 million people–had pre-diabetes in 2000 New data suggest that at least 54 million US adults had pre-diabetes in 2002 Those with pre-diabetes are likely to develop type 2 diabetes within 10 years, unless they take steps to prevent or delay
diabetes The res 
ults 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
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Diabetes Prevention Program
that weight loss–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
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
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 US Government does not endorse or favor any specific commercial product or company Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory
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Diabetes Prevention Program
National Diabetes Information Clearinghouse
1 Information Way Bethesda, MD 208923560 Phone: 18008608747 Fax: 7037384929 Email:
ndic@infoniddknihgov Internet: wwwdiabetesniddknihgov The National Diabetes Information Clearinghouse NDIC is a service of the National Institute of Diabetes and Digestive and Kidney Diseases NIDDK The NIDDK is part of the National Institutes of Health under the US Department of Health and Human Services Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts This fact sheet was reviewed by David M Nathan, MD, Massachusetts General Hospital
This publication is not copyrighted The Clearinghouse encourages users of this fact sheet to duplicate and distribute as many copies as desired This fact sheet is also available at wwwdiabetesniddknihgov
US DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
NIH Publication No 065099 August
2006
Source:wvdhhr.org
