@article{e54c67008f5547cc9e366fb66375ebad,
title = "Impact of lifestyle and metformin interventions on the risk of progression to diabetes and regression to normal glucose regulation in overweight or obese people with impaired glucose regulation",
abstract = "Objective: Both lifestyle and metformin interventions can delay or prevent progression to type 2 diabetes mellitus (DM) in people with impaired glucose regulation, but there is considerable interindividual variation in the likelihood of receiving benefit. Understanding an individual's 3-year risk of progressing to DM and regressing to normal glucose regulation (NGR) might facilitate benefit-based tailored treatment. Research Design and Methods: We used the values of 19 clinical variables measured at the Diabetes Prevention Program (DPP) baseline evaluation and Cox proportional hazards models to assess the 3-year risk of progression to DM and regression to NGR separately for DPP lifestyle, metformin, and placebo participants who were adherent to the interventions. Lifestyle participantswho lost ≥5% of their initial body weight at 6 months and metformin and placebo participants who reported taking ≥80% of their prescribed medication at the 6-month follow-up were defined as adherent. Results: Eleven of 19 clinical variables measured at baseline predicted progression to DM, and 6 of 19 predicted regression to NGR. Compared with adherent placebo participants at lowest risk of developing diabetes, participants at lowest risk of developing diabetes who adhered to a lifestyle intervention had an 8% absolute risk reduction (ARR) of developing diabetes and a 35% greater absolute likelihood of reverting to NGR. Participants at lowest risk of developing diabetes who adhered to a metformin intervention had no reduction in their risk of developing diabetes and a 17% greater absolute likelihood of reverting to NGR. Participants at highest risk of developingDM who adhered to a lifestyle intervention had a 39% ARR of developing diabetes and a 24% greater absolute likelihood of reverting to NGR, whereas those who adhered to the metformin intervention had a 25% ARR of developing diabetes and an 11% greater absolute likelihood of reverting to NGR. Conclusions: Unlike our previous analyses that sought to explain population risk, these analyses evaluate individual risk. The models can be used by overweight and obese adults with fasting hyperglycemia and impaired glucose tolerance to facilitate personalized decision-making by allowing them to explicitly weigh the benefits and feasibility of the lifestyle and metformin interventions.",
author = "{Diabetes Prevention Program Research Group} and Herman, {William H.} and Qing Pan and Edelstein, {Sharon L.} and Mather, {Kieren J.} and Leigh Perreault and Elizabeth Barrett-Connor and Dabelea, {Dana M.} and Edward Horton and Kahn, {Steven E.} and Knowler, {William C.} and Carlos Lorenzo and Xavier Pi-Sunyer and Elizabeth Venditti and Wen Ye",
note = "Funding Information: gratefully acknowledges the commitment and dedication of the participants of the DPP and DPPOS. Funding. This work was supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant U01-DK-048489. During the DPP and DPPOS, the NIDDK of the National Institutes of Health provided funding to the clinical centers and the Coordinating Center for the design and conduct of the study and collection, management, analysis, and interpretation of the data. The Southwestern American Indian Center was supported directly by the NIDDK, including its Intramural Research Program, and the Indian Health Service. The General Clinical Research Center, National Center for Research Resources, and the U.S. Department of Veterans Affairs supported data collection at many of the clinical centers. Funding was also providedbytheNationalInstituteofChildHealth and Human Development, the National Institute onAging,theNationalEyeInstitute,theNational Heart, Lung, and Blood Institute, the National Cancer Institute, the Office of Research on Women{\textquoteright}s Health, the National Institute on Minority Health and Health Disparities, the Centers for Disease Control and Prevention, and the American Diabetes Association. This research was also supported, in part, by the Intramural Research Program of the NIDDK. Bristol-Myers Squibb and Parke-Davis provided additional funding and material support during the DPP, Merck Lipha Health provided medication, and LifeScan, Inc. donated materials during the DPP and DPPOS. LifeScan, Inc., Health O Meter, Hoechst Marion Roussel Inc., Merck-MedcoManaged Care, Merck & Co., Inc., Nike Inc., SlimFast, andQuakerOats Company donated materials, equipment, or medicines for concomitant conditions. McKesson BioServices, Matthews Media Group, Inc., and the Henry M. Jackson Foundation provided support services under subcontract with the Coordinating Center. Duality of Interest. L.P. has received personal fees from Novo Nordisk, AstraZeneca, Janssen, Boehringer Ingelheim, Eli Lilly and Company, Orexigen Therapeutics, Inc., Merck, and Sanofi. No other potential conflicts of interest relevant to this article were reported. Publisher Copyright: {\textcopyright} 2017 by the American Diabetes Association.",
year = "2017",
month = dec,
day = "1",
doi = "10.2337/dc17-1116",
language = "English (US)",
volume = "40",
pages = "1668--1677",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "12",
}