Articles

Posted Apr 23 , 2018 09:32 AM

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

Herman WH, et al. Diabetes Care 2017;40:1668-1677

What were the findings (excerpted from the Abstract)?

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. The authors 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 participants who lost ≥5% of their initial bodyweight 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. 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 developing DM 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.

Why is this important?

We have known for some time that we can reduce the risk of developing diabetes in a population at risk (people with prediabetes). What clinicians want to know is for any one individual patient what is the risk reduction for that person when interventions such as lifestyle change and/or metformin therapy are used. Unlike our previous analyses that sought to explain population risk, these analyses evaluate individual risk. The models can be used for overweight and obese adults with fasting hyperglycemia and impaired glucose tolerance to facilitate personalized decision-making by allowing healthcare providers to explicitly weigh the benefits and feasibility of the lifestyle and metformin interventions. Sadly, once prediabetes is discovered, there is a modest reduction in risk over the long term even when strenuously adhering to lifestyle changes or metformin therapy. In the future, models of diabetes risk prediction will be more available, and will be uploaded to the DPPOS website so that patients and clinicians can assess the likelihood of development of diabetes or regression to normal glucose regulation with different interventions. Patients should be aware of their individual risk, and the onus of adherence to whatever regimen is chosen in shared decision making with the clinician.

Read the Abstract:
http://care.diabetesjournals.org/content/40/12/1668