Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin
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Overview
Randomized trial demonstrates reduced type 2 diabetes incidence with lifestyle intervention or metformin in high-risk adults, indicating behavioral modification is more effective than drug therapy.
Key Points
To determine whether modifying reversible risk factors through a lifestyle-intervention program or metformin administration prevents or delays the onset of type 2 diabetes in high-risk individuals.
Randomly assigned 3,234 nondiabetic adults with elevated fasting and post-load plasma glucose (mean age 51 years, mean BMI 34.0) to placebo, metformin (850 mg twice daily), or a lifestyle-modification program.
Targeted at least 7% weight loss and at least 150 minutes of physical activity per week in the lifestyle arm, monitoring participants over an average follow-up of 2.8 years.
Incidence of diabetes was 11.0 cases per 100 person-years in the placebo group, 7.8 in the metformin group, and 4.8 in the lifestyle group.
Lifestyle intervention reduced diabetes incidence by 58% (95% CI, 48% to 66%) and metformin reduced incidence by 31% (95% CI, 17% to 43%) compared with placebo, with lifestyle significantly outperforming metformin.
Number needed to treat to prevent one case of diabetes over three years was 6.9 persons for lifestyle intervention and 13.9 persons for metformin.