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Preventing Diabetes by Lifestyle Modification vs. Drug Therapy

Intensive lifestyle change is more effective than metformin in preventing type 2 diabetes.

Results from several studies show that diet and exercise can reduce the incidence of type 2 diabetes in certain populations. In this multicenter U.S. trial, 3234 adults at high risk for diabetes were randomized to 3 intervention groups: standard lifestyle recommendations plus metformin (850 mg twice daily); standard lifestyle recommendations plus placebo; or intensive lifestyle modification (goal, at least 7% weight reduction and 150 minutes of exercise weekly).

Enrollment criteria included body-mass index (BMI) of 24 or higher, fasting plasma glucose of 95 mg/dL to 125 mg/dL, and plasma glucose of 140 mg/dL to 199 mg/dL 2 hours after an oral glucose load. Mean baseline BMI was 34. During an average follow-up of 2.8 years, incidence of newly diagnosed diabetes was significantly lower in the intensive-lifestyle-intervention group than in the metformin group and was significantly lower in the metformin group than in the placebo group (4.8 vs. 7.8 vs. 11.0 cases per 100 person-years). This pattern of response was similar among men and women and among all ethnic and racial groups. Rate of gastrointestinal symptoms was significantly higher in the metformin group than in the other 2 groups.

Comment: Intensive lifestyle intervention prevented diabetes more effectively than did metformin, which in turn was more effective than placebo. The results underscore the tangible benefits of weight reduction and exercise, but the lifestyle intervention in this trial was labor-intensive: Each person in that group received a 16-lesson educational intervention, which was taught one-to-one by specially trained case managers.

— Allan S. Brett, MD

Published in Journal Watch General Medicine February 19, 2002

Citation(s):

Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002 Feb 7; 346:393-403.

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