May 30, 2022

Diabetes:Does a long-term study strengthen or change prevention strategies?

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The Diabetes Prevention Program (DPP) demonstrated two decades ago that type 2 diabetes might be slowed or prevented in those diagnosed with early symptoms (prediabetes). A low-calorie healthy diet combined with at least 150 minutes of activity was one strategy examined to help individuals lose at least 7% of their body weight. Metformin, a common diabetes treatment, was another option. Both were compared to a placebo (fake) pill control group.

A new follow-up study looked at death rates from cancer, cardiovascular disease, and all causes in later years, and the results for each group were surprising in various respects.


What are the benefits of slowing or preventing diabetes?

Diabetes type 2 is one of the most common long-term conditions in the world. It can lead to heart disease, nerve damage, eye issues, and renal problems over time, increasing the risk of disability and death. If a person's blood tests reveal that they have prediabetes, well-tested strategies can help them delay or prevent the onset of type 2 diabetes. This could help individuals live longer and better lives.

What did the follow-up research reveal?

The findings of the original study suggest that both lifestyle changes and metformin medication can significantly reduce the risk of developing diabetes in people with prediabetes. The risk was reduced by 58% and 31%, respectively when compared to the control group.
The original DPP cohort of 3,234 people was invited to stay in the Diabetes Prevention Program Outcomes Study, a follow-up observation Study (DPPOS). Most of the people in the study have been followed for more than 20 years, giving researchers a unique chance to look at several important health outcomes.
After an average of 21 years, the researchers looked at participant fatalities from any cause, cancer, or cardiovascular disease. Researchers found no difference in death rates between the people in the intensive lifestyle arm of the study and the people in the metformin arm of the study compared to the people in the control group.

Does this imply that these techniques aren't as effective as we had hoped?
Not! To comprehend these outcomes, it is necessary to put things into context.

To begin, all initial DPP study participants were informed of the benefits of intense lifestyle modification and metformin and were invited to remain in the program's observation phase. Because lifestyle change had the biggest impact, researchers were compelled ethically to share the findings with all participants and encourage them to use the strategies. After the DPP trial finished, all participants were offered lifestyle adjustment sessions.

Many of the participants in the follow-up research are likely to have made some positive modifications to their eating habits and physical activity. This would make it hard to figure out how major lifestyle changes affect health in the long run.
Second, just one group of people took metformin in the first trial. In the follow-up study, any participant who got type 2 diabetes was told to talk to their primary care doctor about how to control their blood sugar levels.
For type 2 diabetes, metformin is the first-line treatment. As a result, even if they were in the control or intensive lifestyle modification groups, individuals who got diabetes were frequently administered metformin. The three groups were less distinguishable from one another over time. Statistical tests were used in this new study to eliminate this bias without impacting the primary findings. However, some biases cannot be eliminated.
Overall, death rates in the DPPOS were low. The participants in these trials were a rather healthy group of people who were, on average, 50 years old when the research began. This may explain why death rates are lower than expected when compared to data from worldwide diabetes prevention studies or even other types of diabetes research in the United States.
It's also worth noting that cancer was the top cause of death in the follow-up research, rather than heart issues, strokes, or other forms of cardiovascular illness. Cardiovascular disease has been the leading cause of death in the general population for many years.

Adult-specific measures to decrease cardiovascular disease may have a role to play here. But when researchers compare the death rates of the three groups in the DPPOS, this advantage may make it harder to spot big changes.

What are we going to do with all of this data?

The best course of action is to keep working to prevent or delay diabetes. This is good for us as individuals and for our country as a whole. Based on our investigation, here's what we know.
If you have prediabetes, you should:

Intensive lifestyle adjustment remains the most effective method to lower the risk of type 2 diabetes. It can help you avoid or put off getting diabetes, help you lose weight in other ways, and lower your risk of heart disease and stroke.
Metformin, a low-cost, safe medication with few side effects, also lowers the risk of diabetes. Metformin is especially effective for people under the age of 60, those with a BMI of greater than 35, and women who have had gestational diabetes in the past.
Let's not forget that many other factors may play a part in identifying the optimum type 2 diabetes prevention strategies for each individual. Age, the colour of skin and ethnicity, other medical issues, total type 2 diabetes risk, and the types of measures a person can take are all critical considerations. If you have a family history of diabetes, or if you have prediabetes or are concerned about getting diabetes, talk to your doctor about the optimal mix of preventative interventions for you.

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