10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study

被引：2195

作者：

Bray, G. A. ^{[1
,2
]}

Chatellier, A. ^{[2
]}

Duncan, C. ^{[2
]}

Greenway, F. L. ^{[2
]}

Levy, E. ^{[2
]}

Ryan, D. H. ^{[2
]}

Polonsky, K. S. ^{[3
]}

Tobian, J. ^{[3
]}

Ehrmann, D. ^{[3
]}

Matulik, M. J. ^{[3
]}

Clark, B. ^{[3
]}

Czech, K. ^{[3
]}

DeSandre, C. ^{[3
]}

Hilbrich, R. ^{[3
]}

McNabb, W. ^{[3
]}

Semenske, A. R. ^{[3
]}

Goldstein, B. J. ^{[4
]}

Smith, K. A. ^{[4
]}

Wildman, W. ^{[4
]}

Pepe, C. ^{[4
]}

Goldberg, R. B. ^{[5
]}

Calles, J. ^{[5
]}

Ojito, J. ^{[5
]}

Castillo-Florez, S. ^{[5
]}

Florez, H. J. ^{[5
]}

Giannella, A. ^{[5
]}

Lara, O. ^{[5
]}

Veciana, B. ^{[5
]}

Haffner, S. M. ^{[6
]}

Montez, M. G. ^{[6
]}

Lorenzo, C. ^{[6
]}

Martinez, A. ^{[6
]}

Hamman, R. F. ^{[7
]}

Testaverde, L. ^{[7
]}

Bouffard, A. ^{[7
]}

Dabelea, D. ^{[7
]}

Jenkins, T. ^{[7
]}

Lenz, D. ^{[7
]}

Perreault, L. ^{[7
]}

Price, D. W. ^{[7
]}

Steinke, S. C. ^{[7
]}

Horton, E. S. ^{[8
]}

Poirier, C. S. ^{[8
]}

Swift, K. ^{[8
]}

Caballero, E. ^{[8
]}

Jackson, S. D. ^{[8
]}

Lambert, L. ^{[8
]}

Lawton, K. E. ^{[8
]}

Ledbury, S. ^{[8
]}

Kahn, S. E. ^{[9
]}

机构：

[1] George Washington Univ, Diabet Prevent Program Coordinating Ctr, Ctr Biostat, Rockville, MD 20852 USA

[2] Pennington Biomed Res Ctr, Baton Rouge, LA USA

[3] Univ Chicago, Chicago, IL 60637 USA

[4] Thomas Jefferson Univ, Jefferson Med Coll, Philadelphia, PA 19107 USA

[5] Univ Miami, Miami, FL USA

[6] Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA

[7] Univ Colorado, Denver, CO 80202 USA

[8] Joslin Diabet Ctr, Boston, MA 02215 USA

[9] Univ Washington, Seattle, WA 98195 USA

[10] Univ Tennessee, Memphis, TN USA

[11] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA

[12] Massachusetts Gen Hosp, Boston, MA 02114 USA

[13] Univ Calif San Diego, San Diego, CA 92103 USA

[14] St Lukes Roosevelt Hosp, New York, NY 10025 USA

[15] Indiana Univ, Indianapolis, IN 46204 USA

[16] Medstar Res Inst, Washington, DC USA

[17] Univ Calif Los Angeles, Univ So Calif, Res Ctr, Alhambra, CA USA

[18] Washington Univ, St Louis, MO USA

[19] Johns Hopkins Sch Med, Baltimore, MD USA

[20] Univ New Mexico, Albuquerque, NM 87131 USA

[21] Albert Einstein Coll Med, Bronx, NY 10467 USA

[22] Univ Pittsburgh, Pittsburgh, PA USA

[23] Univ Hawaii, Honolulu, HI 96822 USA

[24] SW Amer Indian Ctr, Phoenix, AZ USA

[25] SW Amer Indian Ctr, Shiprock, NM USA

[26] SW Amer Indian Ctr, Zuni, NM USA

[27] Cent Biochem Lab, Seattle, WA USA

[28] Epidemiol Cardiol Res Ctr Epicare, Winston Salem, NC USA

[29] NIDDK, NIH, Bethesda, MD USA

[30] Nutr Coding Ctr, Columbia, SC USA

[31] Qual Well Being Ctr, La Jolla, CA USA

来源：

LANCET | 2009年 / 374卷 / 9702期

基金：

美国国家卫生研究院;

关键词：

IMPAIRED GLUCOSE-TOLERANCE; LIFE-STYLE; PEOPLE; MELLITUS; RISK;

D O I：

10.1016/S0140-6736(09)61457-4

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Background In the 2.8 years of the Diabetes Prevention Program (DPP) randomised clinical trial, diabetes incidence in high-risk adults was reduced by 58% with intensive lifestyle intervention and by 31% with metformin, compared with placebo. We investigated the persistence of these effects in the long term. Methods All active DPP participants were eligible for continued follow-up. 2766 of 3150 (88%) enrolled for a median additional follow-up of 5.7 years (IQR 5.5-5.8). 910 participants were from the lifestyle, 924 from the metformin, and 932 were from the original placebo groups. On the basis of the benefits from the intensive lifestyle intervention in the DPP, all three groups were offered group-implemented lifestyle intervention. Metformin treatment was continued in the original metformin group (850 mg twice daily as tolerated), with participants unmasked to assignment, and the original lifestyle intervention group was offered additional lifestyle support. The primary outcome was development of diabetes according to American Diabetes Association criteria. Analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00038727. Findings During the 10.0-year (IQR 9.0-10.5) follow-up since randomisation to DPP, the original lifestyle group lost, then partly regained weight. The modest weight loss with metformin was maintained. Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years (95% CI 4.1-5.7) in the intensive lifestyle intervention group, 7.8 (6.8-8.8) in the metformin group, and 11.0 (9.8-12.3) in the placebo group. Diabetes incidence rates in this follow-up study were similar between treatment groups: 5.9 per 100 person-years (5.1-6.8) for lifestyle, 4.9 (4.2-5.7) for metformin, and 5.6 (4.8-6.5) for placebo. Diabetes incidence in the 10 years since DPP randomisation was reduced by 34% (24-42) in the lifestyle group and 18% (7-28) in the metformin group compared with placebo. Interpretation During follow-up after DPP, incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group, but the cumulative incidence of diabetes remained lowest in the lifestyle group. Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years.

引用

页码：1677 / 1686

页数：10

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