Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
William C Knowler, Elizabeth Barrett-Connor, Sarah E Fowler, Richard F Hamman, John M Lachin, Elizabeth A Walker, David M Nathan, Diabetes Prevention Program Research Group, William C Knowler, Elizabeth Barrett-Connor, Sarah E Fowler, Richard F Hamman, John M Lachin, Elizabeth A Walker, David M Nathan, Diabetes Prevention Program Research Group
Abstract
Background: Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes.
Methods: We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups.
Results: The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.
Conclusions: Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
Figures
![Figure 1.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1370926/bin/nihms-5217-0001.jpg)
Figure 2.
Cumulative Incidence of Diabetes According…
Figure 2.
Cumulative Incidence of Diabetes According to Study Group. The diagnosis of diabetes was…
Figure 3.
Fasting Plasma Glucose Concentrations (Panel…
Figure 3.
Fasting Plasma Glucose Concentrations (Panel A) and Glycosylated Hemoglobin Values (Panel B) According…
Figure 4.
Participants with Normal Plasma Glucose…
Figure 4.
Participants with Normal Plasma Glucose Values, According to Study Group. Panel A shows…
- Diabetes prevention.Bo-Abbas YY. Bo-Abbas YY. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. doi: 10.1056/NEJM200206063462316. N Engl J Med. 2002. PMID: 12050348 No abstract available.
- Diabetes prevention.Brousseau VJ. Brousseau VJ. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. N Engl J Med. 2002. PMID: 12051267 No abstract available.
- Diabetes prevention.Louria DB. Louria DB. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. N Engl J Med. 2002. PMID: 12051268 No abstract available.
- Diabetes prevention.Benjamin SM, Valdez R, Vinicor F. Benjamin SM, et al. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. N Engl J Med. 2002. PMID: 12051269 No abstract available.
- A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in persons at risk.Montori VM. Montori VM. ACP J Club. 2002 Sep-Oct;137(2):55. ACP J Club. 2002. PMID: 12207433 No abstract available.
- A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in people at risk.Greene B. Greene B. Evid Based Nurs. 2002 Oct;5(4):109. doi: 10.1136/ebn.5.4.109. Evid Based Nurs. 2002. PMID: 12402812 No abstract available.
- Does a combined program of dietary modification and physical activity or the use of metformin reduce the conversion from impaired glucose tolerance to type 2 diabetes?Mackerras DE. Mackerras DE. Med J Aust. 2003 Feb 17;178(4):180-1. doi: 10.5694/j.1326-5377.2003.tb05138.x. Med J Aust. 2003. PMID: 12580748 No abstract available.
- Lifestyle intervention or treatment with metformin. Which delays onset of type 2 diabetes?Leung M, Kwan D, Evans MF. Leung M, et al. Can Fam Physician. 2004 Mar;50:369-71. Can Fam Physician. 2004. PMID: 15318673 Free PMC article. No abstract available.
- The diabetes prevention program and its global implications.Molitch ME, Fujimoto W, Hamman RF, Knowler WC; Diabetes Prevention Program Research Group. Molitch ME, et al. J Am Soc Nephrol. 2003 Jul;14(7 Suppl 2):S103-7. doi: 10.1097/01.asn.0000070140.62190.97. J Am Soc Nephrol. 2003. PMID: 12819312 Free PMC article. Clinical Trial.
- 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.Diabetes Prevention Program Research Group; Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. Diabetes Prevention Program Research Group, et al. Lancet. 2009 Nov 14;374(9702):1677-86. doi: 10.1016/S0140-6736(09)61457-4. Epub 2009 Oct 29. Lancet. 2009. PMID: 19878986 Free PMC article. Clinical Trial.
- Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance.Florez H, Temprosa MG, Orchard TJ, Mather KJ, Marcovina SM, Barrett-Connor E, Horton E, Saudek C, Pi-Sunyer XF, Ratner RE, Goldberg RB; Diabetes Prevention Program Research Group. Florez H, et al. Diabetes Obes Metab. 2014 Apr;16(4):326-33. doi: 10.1111/dom.12220. Epub 2013 Oct 29. Diabetes Obes Metab. 2014. PMID: 24118860 Free PMC article. Clinical Trial.
- [Steps toward the primary prevention of type II diabetes mellitus. Various epidemiological considerations].Flórez H. Flórez H. Invest Clin. 1997 Mar;38(1):39-52. Invest Clin. 1997. PMID: 9235072 Review. Spanish.
- Insulin secretagogues for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus.Hemmingsen B, Sonne DP, Metzendorf MI, Richter B. Hemmingsen B, et al. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD012151. doi: 10.1002/14651858.CD012151.pub2. Cochrane Database Syst Rev. 2016. PMID: 27749986 Free PMC article. Review.
- Barriers to Prevention and Treatment of Type 2 Diabetes Mellitus Among Outpatients in Belarus.Sachkouskaya A, Sharshakova T, Kovalevsky D, Rusalenko M, Savasteeva I, Goto A, Yokokawa H, Kumagai A, Takahashi J. Sachkouskaya A, et al. Front Clin Diabetes Healthc. 2022 Jan 6;2:797857. doi: 10.3389/fcdhc.2021.797857. eCollection 2021. Front Clin Diabetes Healthc. 2022. PMID: 36994323 Free PMC article.
- Obesity and cardiovascular disease: An executive document on pathophysiological and clinical links promoted by the Italian Society of Cardiovascular Prevention (SIPREC).Volpe M, Gallo G. Volpe M, et al. Front Cardiovasc Med. 2023 Mar 13;10:1136340. doi: 10.3389/fcvm.2023.1136340. eCollection 2023. Front Cardiovasc Med. 2023. PMID: 36993998 Free PMC article.
- Identifying the Associations of Nightly Fasting Duration and Meal Timing with Type 2 Diabetes Mellitus Using Data from the 2016-2020 Korea National Health and Nutrition Survey.Kwak J, Jang KA, Kim HR, Kang MS, Lee KW, Shin D. Kwak J, et al. Nutrients. 2023 Mar 13;15(6):1385. doi: 10.3390/nu15061385. Nutrients. 2023. PMID: 36986116 Free PMC article.
- Soy Consumption and the Risk of Type 2 Diabetes and Cardiovascular Diseases: A Systematic Review and Meta-Analysis.Zuo X, Zhao R, Wu M, Wan Q, Li T. Zuo X, et al. Nutrients. 2023 Mar 10;15(6):1358. doi: 10.3390/nu15061358. Nutrients. 2023. PMID: 36986086 Free PMC article. Review.
- Therapeutic Physical Exercise Programs in the Context of NASH Cirrhosis and Liver Transplantation: A Systematic Review.Farrugia MA, Le Garf S, Chierici A, Piche T, Gual P, Iannelli A, Anty R. Farrugia MA, et al. Metabolites. 2023 Feb 23;13(3):330. doi: 10.3390/metabo13030330. Metabolites. 2023. PMID: 36984770 Free PMC article. Review.
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
- Research Support, Non-U.S. Gov't
- Research Support, U.S. Gov't, P.H.S.
- Adult
- Blood Glucose / metabolism
- Body Mass Index
- Diabetes Mellitus, Type 2 / epidemiology
- Diabetes Mellitus, Type 2 / prevention & control*
- Double-Blind Method
- Energy Intake
- Exercise*
- Female
- Humans
- Hypoglycemic Agents / adverse effects
- Hypoglycemic Agents / therapeutic use*
- Incidence
- Life Style*
- Male
- Metformin / adverse effects
- Metformin / therapeutic use*
- Middle Aged
- Patient Compliance
- Risk Factors
- Weight Loss*
- Blood Glucose
- Hypoglycemic Agents
- Metformin
- Full Text Sources
- Other Literature Sources
- Medical
NCBI Literature Resources
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
![Figure 2.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1370926/bin/nihms-5217-0002.jpg)
Figure 3.
Fasting Plasma Glucose Concentrations (Panel…
Figure 3.
Fasting Plasma Glucose Concentrations (Panel A) and Glycosylated Hemoglobin Values (Panel B) According…
Figure 4.
Participants with Normal Plasma Glucose…
Figure 4.
Participants with Normal Plasma Glucose Values, According to Study Group. Panel A shows…
- Diabetes prevention.Bo-Abbas YY. Bo-Abbas YY. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. doi: 10.1056/NEJM200206063462316. N Engl J Med. 2002. PMID: 12050348 No abstract available.
- Diabetes prevention.Brousseau VJ. Brousseau VJ. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. N Engl J Med. 2002. PMID: 12051267 No abstract available.
- Diabetes prevention.Louria DB. Louria DB. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. N Engl J Med. 2002. PMID: 12051268 No abstract available.
- Diabetes prevention.Benjamin SM, Valdez R, Vinicor F. Benjamin SM, et al. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. N Engl J Med. 2002. PMID: 12051269 No abstract available.
- A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in persons at risk.Montori VM. Montori VM. ACP J Club. 2002 Sep-Oct;137(2):55. ACP J Club. 2002. PMID: 12207433 No abstract available.
- A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in people at risk.Greene B. Greene B. Evid Based Nurs. 2002 Oct;5(4):109. doi: 10.1136/ebn.5.4.109. Evid Based Nurs. 2002. PMID: 12402812 No abstract available.
- Does a combined program of dietary modification and physical activity or the use of metformin reduce the conversion from impaired glucose tolerance to type 2 diabetes?Mackerras DE. Mackerras DE. Med J Aust. 2003 Feb 17;178(4):180-1. doi: 10.5694/j.1326-5377.2003.tb05138.x. Med J Aust. 2003. PMID: 12580748 No abstract available.
- Lifestyle intervention or treatment with metformin. Which delays onset of type 2 diabetes?Leung M, Kwan D, Evans MF. Leung M, et al. Can Fam Physician. 2004 Mar;50:369-71. Can Fam Physician. 2004. PMID: 15318673 Free PMC article. No abstract available.
- The diabetes prevention program and its global implications.Molitch ME, Fujimoto W, Hamman RF, Knowler WC; Diabetes Prevention Program Research Group. Molitch ME, et al. J Am Soc Nephrol. 2003 Jul;14(7 Suppl 2):S103-7. doi: 10.1097/01.asn.0000070140.62190.97. J Am Soc Nephrol. 2003. PMID: 12819312 Free PMC article. Clinical Trial.
- 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.Diabetes Prevention Program Research Group; Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. Diabetes Prevention Program Research Group, et al. Lancet. 2009 Nov 14;374(9702):1677-86. doi: 10.1016/S0140-6736(09)61457-4. Epub 2009 Oct 29. Lancet. 2009. PMID: 19878986 Free PMC article. Clinical Trial.
- Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance.Florez H, Temprosa MG, Orchard TJ, Mather KJ, Marcovina SM, Barrett-Connor E, Horton E, Saudek C, Pi-Sunyer XF, Ratner RE, Goldberg RB; Diabetes Prevention Program Research Group. Florez H, et al. Diabetes Obes Metab. 2014 Apr;16(4):326-33. doi: 10.1111/dom.12220. Epub 2013 Oct 29. Diabetes Obes Metab. 2014. PMID: 24118860 Free PMC article. Clinical Trial.
- [Steps toward the primary prevention of type II diabetes mellitus. Various epidemiological considerations].Flórez H. Flórez H. Invest Clin. 1997 Mar;38(1):39-52. Invest Clin. 1997. PMID: 9235072 Review. Spanish.
- Insulin secretagogues for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus.Hemmingsen B, Sonne DP, Metzendorf MI, Richter B. Hemmingsen B, et al. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD012151. doi: 10.1002/14651858.CD012151.pub2. Cochrane Database Syst Rev. 2016. PMID: 27749986 Free PMC article. Review.
- Barriers to Prevention and Treatment of Type 2 Diabetes Mellitus Among Outpatients in Belarus.Sachkouskaya A, Sharshakova T, Kovalevsky D, Rusalenko M, Savasteeva I, Goto A, Yokokawa H, Kumagai A, Takahashi J. Sachkouskaya A, et al. Front Clin Diabetes Healthc. 2022 Jan 6;2:797857. doi: 10.3389/fcdhc.2021.797857. eCollection 2021. Front Clin Diabetes Healthc. 2022. PMID: 36994323 Free PMC article.
- Obesity and cardiovascular disease: An executive document on pathophysiological and clinical links promoted by the Italian Society of Cardiovascular Prevention (SIPREC).Volpe M, Gallo G. Volpe M, et al. Front Cardiovasc Med. 2023 Mar 13;10:1136340. doi: 10.3389/fcvm.2023.1136340. eCollection 2023. Front Cardiovasc Med. 2023. PMID: 36993998 Free PMC article.
- Identifying the Associations of Nightly Fasting Duration and Meal Timing with Type 2 Diabetes Mellitus Using Data from the 2016-2020 Korea National Health and Nutrition Survey.Kwak J, Jang KA, Kim HR, Kang MS, Lee KW, Shin D. Kwak J, et al. Nutrients. 2023 Mar 13;15(6):1385. doi: 10.3390/nu15061385. Nutrients. 2023. PMID: 36986116 Free PMC article.
- Soy Consumption and the Risk of Type 2 Diabetes and Cardiovascular Diseases: A Systematic Review and Meta-Analysis.Zuo X, Zhao R, Wu M, Wan Q, Li T. Zuo X, et al. Nutrients. 2023 Mar 10;15(6):1358. doi: 10.3390/nu15061358. Nutrients. 2023. PMID: 36986086 Free PMC article. Review.
- Therapeutic Physical Exercise Programs in the Context of NASH Cirrhosis and Liver Transplantation: A Systematic Review.Farrugia MA, Le Garf S, Chierici A, Piche T, Gual P, Iannelli A, Anty R. Farrugia MA, et al. Metabolites. 2023 Feb 23;13(3):330. doi: 10.3390/metabo13030330. Metabolites. 2023. PMID: 36984770 Free PMC article. Review.
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
- Research Support, Non-U.S. Gov't
- Research Support, U.S. Gov't, P.H.S.
- Adult
- Blood Glucose / metabolism
- Body Mass Index
- Diabetes Mellitus, Type 2 / epidemiology
- Diabetes Mellitus, Type 2 / prevention & control*
- Double-Blind Method
- Energy Intake
- Exercise*
- Female
- Humans
- Hypoglycemic Agents / adverse effects
- Hypoglycemic Agents / therapeutic use*
- Incidence
- Life Style*
- Male
- Metformin / adverse effects
- Metformin / therapeutic use*
- Middle Aged
- Patient Compliance
- Risk Factors
- Weight Loss*
- Blood Glucose
- Hypoglycemic Agents
- Metformin
- Full Text Sources
- Other Literature Sources
- Medical
NCBI Literature Resources
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
![Figure 3.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1370926/bin/nihms-5217-0003.jpg)
Figure 4.
Participants with Normal Plasma Glucose…
Figure 4.
Participants with Normal Plasma Glucose Values, According to Study Group. Panel A shows…
- Diabetes prevention.Bo-Abbas YY. Bo-Abbas YY. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. doi: 10.1056/NEJM200206063462316. N Engl J Med. 2002. PMID: 12050348 No abstract available.
- Diabetes prevention.Brousseau VJ. Brousseau VJ. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. N Engl J Med. 2002. PMID: 12051267 No abstract available.
- Diabetes prevention.Louria DB. Louria DB. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. N Engl J Med. 2002. PMID: 12051268 No abstract available.
- Diabetes prevention.Benjamin SM, Valdez R, Vinicor F. Benjamin SM, et al. N Engl J Med. 2002 Jun 6;346(23):1829-30; author reply 1829-30. N Engl J Med. 2002. PMID: 12051269 No abstract available.
- A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in persons at risk.Montori VM. Montori VM. ACP J Club. 2002 Sep-Oct;137(2):55. ACP J Club. 2002. PMID: 12207433 No abstract available.
- A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in people at risk.Greene B. Greene B. Evid Based Nurs. 2002 Oct;5(4):109. doi: 10.1136/ebn.5.4.109. Evid Based Nurs. 2002. PMID: 12402812 No abstract available.
- Does a combined program of dietary modification and physical activity or the use of metformin reduce the conversion from impaired glucose tolerance to type 2 diabetes?Mackerras DE. Mackerras DE. Med J Aust. 2003 Feb 17;178(4):180-1. doi: 10.5694/j.1326-5377.2003.tb05138.x. Med J Aust. 2003. PMID: 12580748 No abstract available.
- Lifestyle intervention or treatment with metformin. Which delays onset of type 2 diabetes?Leung M, Kwan D, Evans MF. Leung M, et al. Can Fam Physician. 2004 Mar;50:369-71. Can Fam Physician. 2004. PMID: 15318673 Free PMC article. No abstract available.
- The diabetes prevention program and its global implications.Molitch ME, Fujimoto W, Hamman RF, Knowler WC; Diabetes Prevention Program Research Group. Molitch ME, et al. J Am Soc Nephrol. 2003 Jul;14(7 Suppl 2):S103-7. doi: 10.1097/01.asn.0000070140.62190.97. J Am Soc Nephrol. 2003. PMID: 12819312 Free PMC article. Clinical Trial.
- 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.Diabetes Prevention Program Research Group; Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. Diabetes Prevention Program Research Group, et al. Lancet. 2009 Nov 14;374(9702):1677-86. doi: 10.1016/S0140-6736(09)61457-4. Epub 2009 Oct 29. Lancet. 2009. PMID: 19878986 Free PMC article. Clinical Trial.
- Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance.Florez H, Temprosa MG, Orchard TJ, Mather KJ, Marcovina SM, Barrett-Connor E, Horton E, Saudek C, Pi-Sunyer XF, Ratner RE, Goldberg RB; Diabetes Prevention Program Research Group. Florez H, et al. Diabetes Obes Metab. 2014 Apr;16(4):326-33. doi: 10.1111/dom.12220. Epub 2013 Oct 29. Diabetes Obes Metab. 2014. PMID: 24118860 Free PMC article. Clinical Trial.
- [Steps toward the primary prevention of type II diabetes mellitus. Various epidemiological considerations].Flórez H. Flórez H. Invest Clin. 1997 Mar;38(1):39-52. Invest Clin. 1997. PMID: 9235072 Review. Spanish.
- Insulin secretagogues for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus.Hemmingsen B, Sonne DP, Metzendorf MI, Richter B. Hemmingsen B, et al. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD012151. doi: 10.1002/14651858.CD012151.pub2. Cochrane Database Syst Rev. 2016. PMID: 27749986 Free PMC article. Review.
- Barriers to Prevention and Treatment of Type 2 Diabetes Mellitus Among Outpatients in Belarus.Sachkouskaya A, Sharshakova T, Kovalevsky D, Rusalenko M, Savasteeva I, Goto A, Yokokawa H, Kumagai A, Takahashi J. Sachkouskaya A, et al. Front Clin Diabetes Healthc. 2022 Jan 6;2:797857. doi: 10.3389/fcdhc.2021.797857. eCollection 2021. Front Clin Diabetes Healthc. 2022. PMID: 36994323 Free PMC article.
- Obesity and cardiovascular disease: An executive document on pathophysiological and clinical links promoted by the Italian Society of Cardiovascular Prevention (SIPREC).Volpe M, Gallo G. Volpe M, et al. Front Cardiovasc Med. 2023 Mar 13;10:1136340. doi: 10.3389/fcvm.2023.1136340. eCollection 2023. Front Cardiovasc Med. 2023. PMID: 36993998 Free PMC article.
- Identifying the Associations of Nightly Fasting Duration and Meal Timing with Type 2 Diabetes Mellitus Using Data from the 2016-2020 Korea National Health and Nutrition Survey.Kwak J, Jang KA, Kim HR, Kang MS, Lee KW, Shin D. Kwak J, et al. Nutrients. 2023 Mar 13;15(6):1385. doi: 10.3390/nu15061385. Nutrients. 2023. PMID: 36986116 Free PMC article.
- Soy Consumption and the Risk of Type 2 Diabetes and Cardiovascular Diseases: A Systematic Review and Meta-Analysis.Zuo X, Zhao R, Wu M, Wan Q, Li T. Zuo X, et al. Nutrients. 2023 Mar 10;15(6):1358. doi: 10.3390/nu15061358. Nutrients. 2023. PMID: 36986086 Free PMC article. Review.
- Therapeutic Physical Exercise Programs in the Context of NASH Cirrhosis and Liver Transplantation: A Systematic Review.Farrugia MA, Le Garf S, Chierici A, Piche T, Gual P, Iannelli A, Anty R. Farrugia MA, et al. Metabolites. 2023 Feb 23;13(3):330. doi: 10.3390/metabo13030330. Metabolites. 2023. PMID: 36984770 Free PMC article. Review.
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
- Research Support, Non-U.S. Gov't
- Research Support, U.S. Gov't, P.H.S.
- Adult
- Blood Glucose / metabolism
- Body Mass Index
- Diabetes Mellitus, Type 2 / epidemiology
- Diabetes Mellitus, Type 2 / prevention & control*
- Double-Blind Method
- Energy Intake
- Exercise*
- Female
- Humans
- Hypoglycemic Agents / adverse effects
- Hypoglycemic Agents / therapeutic use*
- Incidence
- Life Style*
- Male
- Metformin / adverse effects
- Metformin / therapeutic use*
- Middle Aged
- Patient Compliance
- Risk Factors
- Weight Loss*
- Blood Glucose
- Hypoglycemic Agents
- Metformin
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 4.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1370926/bin/nihms-5217-0004.jpg)
Source: PubMed