Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study
Diabetes Prevention Program Outcomes Study Research Group, T J Orchard, M Temprosa, E Barrett-Connor, S E Fowler, R B Goldberg, K J Mather, S M Marcovina, M Montez, R E Ratner, C D Saudek, H Sherif, K E Watson, George A Bray, Annie Chatellier, Crystal Duncan, Frank L Greenway, Erma Levy, Donna H Ryan, Kenneth S Polonsky, Janet Tobian, David Ehrmann, Margaret J Matulik, Bart Clark, Kirsten Czech, Catherine DeSandre, Ruthanne Hilbrich, Wylie McNabb, Ann R Semenske, Barry J Goldstein, Kevin Furlong, Kellie A Smith, Wendi Wildman, Constance Pepe, Ronald B Goldberg, Jeanette Calles, Juliet Ojito, Sumaya Castillo-Florez, Hermes J Florez, Anna Giannella, Olga Lara, Beth Veciana, Steven M Haffner, Helen P Hazuda, Maria G Montez, Carlos Lorenzo, Arlene Martinez, Richard F Hamman, Lisa Testaverde, Alexis Bouffard, Dana Dabelea, Tonya Jenkins, Dione Lenz, Leigh Perreault, David W Price, Sheila C Steinke, Edward S Horton, Catherine S Poirier, Kati Swift, Enrique Caballero, Sharon D Jackson, Lori Lambert, Kathleen E Lawton, Sarah Ledbury, Steven E Kahn, Brenda K Montgomery, Wilfred Fujimoto, Robert H Knopp, Edward W Lipkin, Michelle Marr, Anne Murillo, Dace Trence, Abbas E Kitabchi, Mary E Murphy, William B Applegate, Michael Bryer-Ash, Samuel Dagogo-Jack, Sandra L Frieson, Helen Lambeth, Lynne C Lichtermann, Hooman Otkaei, Lily M K Rutledge, Amy R Sherman, Clara M Smith, Judith E Soberman, Beverly Williams-Cleaves, Boyd E Metzger, Mark E Molitch, Mariana K Johnson, Mimi M Giles, Diane Larsen, Charlotte Niznik, Samsam C Pen, Pamela A Schinleber, David M Nathan, Charles McKitrick, Heather Turgeon, Kathy Abbott, Ellen Anderson, Laurie Bissett, Enrico Cagliero, Kali D'Anna, Linda Delahanty, Jose C Florez, Valerie Goldman, Alexandra Poulos, Beverly Tseng, Elizabeth Barrett-Connor, Mary Lou Carrion-Petersen, Javiva Horne, Diana Leos, Sundar Mudaliar, Jean Smith, Karen Vejvoda, F Xavier Pi-Sunyer, Jane E Lee, Sandra T Foo, Susan Hagamen, David G Marrero, Susie M Kelly, Ronald T Ackermann, Edwin S Fineberg, Angela Hadden, Marcia A Jackson, Marion S Kirkman, Kieren J Mather, Paris, J Roach, Madelyn L Wheeler, Robert E Ratner, Vanita Aroda, Sue Shapiro, Catherine Bavido-Arrage, Peggy Gibbs, Gabriel Uwaifo, Renee Wiggins, Mohammed F Saad, Karol Watson, Medhat Botrous, Sujata Jinagouda, Maria Budget, Claudia Conzues, Perpetua Magpuri, Kathy Ngo, Kathy Xapthalamous, Neil H White, Samia Das, Ana Santiago, Angela L Brown, Cormarie Wernimont, Christopher D Saudek, Sherita Hill Golden, Tracy Whittington, Jeanne M Clark, Alicia Greene, Dawn Jiggetts, Henry Mosley, John Reusing, Richard R Rubin, Shawne Stephens, Evonne Utsey, David S Schade, Karwyn S Adams, Claire Hemphill, Penny Hyde, Lisa Butler, Janene L Canady, Kathleen Colleran, Ysela Gonzales, Doris A Hernandez-McGinnis, Patricia Katz, Carolyn King, Jill Crandall, Janet O Brown, Elsie Adorno, Helena Duffy, Helen Martinez, Dorothy Pompi, Harry Shamoon, Elizabeth A Walker, Judith Wylie-Rosett, Trevor Orchard, Susan Jeffries, M Kaye Kramer, Marie Smith, Rena R Wing, Andrea Kriska, Jessica Pettigrew, Linda Semler, Elizabeth Venditti, Valarie Weinzierl, Richard F Arakaki, Narleen K Baker-Ladao, Mae K Isonaga, Nina E Bermudez, Marjorie K Mau, William C Knowler, Norman Cooeyate, Mary A Hoskin, Camille Natewa, Carol A Percy, Kelly J Acton, Vickie L Andre, Shandiin Begay, Brian C Bucca, Sherron Cook, Matthew S Doughty, Justin Glass, Martia Glass, Robert L Hanson, Doug Hassenpflug, Louise E Ingraham, Kathleen M Kobus, Jonathan Krakoff, Catherine Manus, Cherie McCabe, Sara Michaels, Tina Morgan, Julie A Nelson, Robert J Roy, Miranda Smart, Darryl P Tonemah, Charlton Wilson, Sarah Fowler, Tina Brenneman, Solome Abebe, Julie Bamdad, Melanie Barkalow, Joel Bethepu, Tsedenia Bezabeh, Jackie Callaghan, Costas Christophi, Sharon L Edelstein, Yuping Gao, Robert Gooding, Adrienne Gottlieb, Nisha Grover, Heather Hoffman, Kathleen Jablonski, Richard Katz, Preethy Kolinjivadi, John M Lachin, Yong Ma, Susan Reamer, Alla Sapozhnikova, Hanna Sherif, Marinella Temprosa, Qing Pan, Mary Foulkes, Nicole Butler, Elizabeth M Venditti, Andrea M Kriska, Linda Semler, Valerie Weinzierl, Santica Marcovina, Greg Strylewicz, John Albers, Ronald J Prineas, Teresa Alexander, Charles Campbell, Sharon Hall, Susan Hensley, Yabing Li, Margaret Mills, Elsayed Soliman, Zhuming Zhang, Ronald Danis, Matthew Davis, Larry Hubbard, Ryan Endres, Deborah Elsas, Samantha Johnson, Vonnie Gama, Anne Goulding, Gregory Evans, Elizabeth Stamm, Jose A Luchsinger, Judith Fradkin, Sanford Garfield, Edward Gregg, Ping Zhang, William H Herman, Morton B Brown, Elizabeth Mayer-Davis, Robert R Moran, Ted Ganiats, Andrew J Sarkin, Naomi Katzir, Erik Groessl, Matthew Budoff, Chris Dailing, Jose C Florez, David Altshuler, Paul I W de Bakker, Paul W Franks, Robert L Hanson, Kathleen Jablonski, William C Knowler, Toni I Pollin, Alan R Shuldiner, Diabetes Prevention Program Outcomes Study Research Group, T J Orchard, M Temprosa, E Barrett-Connor, S E Fowler, R B Goldberg, K J Mather, S M Marcovina, M Montez, R E Ratner, C D Saudek, H Sherif, K E Watson, George A Bray, Annie Chatellier, Crystal Duncan, Frank L Greenway, Erma Levy, Donna H Ryan, Kenneth S Polonsky, Janet Tobian, David Ehrmann, Margaret J Matulik, Bart Clark, Kirsten Czech, Catherine DeSandre, Ruthanne Hilbrich, Wylie McNabb, Ann R Semenske, Barry J Goldstein, Kevin Furlong, Kellie A Smith, Wendi Wildman, Constance Pepe, Ronald B Goldberg, Jeanette Calles, Juliet Ojito, Sumaya Castillo-Florez, Hermes J Florez, Anna Giannella, Olga Lara, Beth Veciana, Steven M Haffner, Helen P Hazuda, Maria G Montez, Carlos Lorenzo, Arlene Martinez, Richard F Hamman, Lisa Testaverde, Alexis Bouffard, Dana Dabelea, Tonya Jenkins, Dione Lenz, Leigh Perreault, David W Price, Sheila C Steinke, Edward S Horton, Catherine S Poirier, Kati Swift, Enrique Caballero, Sharon D Jackson, Lori Lambert, Kathleen E Lawton, Sarah Ledbury, Steven E Kahn, Brenda K Montgomery, Wilfred Fujimoto, Robert H Knopp, Edward W Lipkin, Michelle Marr, Anne Murillo, Dace Trence, Abbas E Kitabchi, Mary E Murphy, William B Applegate, Michael Bryer-Ash, Samuel Dagogo-Jack, Sandra L Frieson, Helen Lambeth, Lynne C Lichtermann, Hooman Otkaei, Lily M K Rutledge, Amy R Sherman, Clara M Smith, Judith E Soberman, Beverly Williams-Cleaves, Boyd E Metzger, Mark E Molitch, Mariana K Johnson, Mimi M Giles, Diane Larsen, Charlotte Niznik, Samsam C Pen, Pamela A Schinleber, David M Nathan, Charles McKitrick, Heather Turgeon, Kathy Abbott, Ellen Anderson, Laurie Bissett, Enrico Cagliero, Kali D'Anna, Linda Delahanty, Jose C Florez, Valerie Goldman, Alexandra Poulos, Beverly Tseng, Elizabeth Barrett-Connor, Mary Lou Carrion-Petersen, Javiva Horne, Diana Leos, Sundar Mudaliar, Jean Smith, Karen Vejvoda, F Xavier Pi-Sunyer, Jane E Lee, Sandra T Foo, Susan Hagamen, David G Marrero, Susie M Kelly, Ronald T Ackermann, Edwin S Fineberg, Angela Hadden, Marcia A Jackson, Marion S Kirkman, Kieren J Mather, Paris, J Roach, Madelyn L Wheeler, Robert E Ratner, Vanita Aroda, Sue Shapiro, Catherine Bavido-Arrage, Peggy Gibbs, Gabriel Uwaifo, Renee Wiggins, Mohammed F Saad, Karol Watson, Medhat Botrous, Sujata Jinagouda, Maria Budget, Claudia Conzues, Perpetua Magpuri, Kathy Ngo, Kathy Xapthalamous, Neil H White, Samia Das, Ana Santiago, Angela L Brown, Cormarie Wernimont, Christopher D Saudek, Sherita Hill Golden, Tracy Whittington, Jeanne M Clark, Alicia Greene, Dawn Jiggetts, Henry Mosley, John Reusing, Richard R Rubin, Shawne Stephens, Evonne Utsey, David S Schade, Karwyn S Adams, Claire Hemphill, Penny Hyde, Lisa Butler, Janene L Canady, Kathleen Colleran, Ysela Gonzales, Doris A Hernandez-McGinnis, Patricia Katz, Carolyn King, Jill Crandall, Janet O Brown, Elsie Adorno, Helena Duffy, Helen Martinez, Dorothy Pompi, Harry Shamoon, Elizabeth A Walker, Judith Wylie-Rosett, Trevor Orchard, Susan Jeffries, M Kaye Kramer, Marie Smith, Rena R Wing, Andrea Kriska, Jessica Pettigrew, Linda Semler, Elizabeth Venditti, Valarie Weinzierl, Richard F Arakaki, Narleen K Baker-Ladao, Mae K Isonaga, Nina E Bermudez, Marjorie K Mau, William C Knowler, Norman Cooeyate, Mary A Hoskin, Camille Natewa, Carol A Percy, Kelly J Acton, Vickie L Andre, Shandiin Begay, Brian C Bucca, Sherron Cook, Matthew S Doughty, Justin Glass, Martia Glass, Robert L Hanson, Doug Hassenpflug, Louise E Ingraham, Kathleen M Kobus, Jonathan Krakoff, Catherine Manus, Cherie McCabe, Sara Michaels, Tina Morgan, Julie A Nelson, Robert J Roy, Miranda Smart, Darryl P Tonemah, Charlton Wilson, Sarah Fowler, Tina Brenneman, Solome Abebe, Julie Bamdad, Melanie Barkalow, Joel Bethepu, Tsedenia Bezabeh, Jackie Callaghan, Costas Christophi, Sharon L Edelstein, Yuping Gao, Robert Gooding, Adrienne Gottlieb, Nisha Grover, Heather Hoffman, Kathleen Jablonski, Richard Katz, Preethy Kolinjivadi, John M Lachin, Yong Ma, Susan Reamer, Alla Sapozhnikova, Hanna Sherif, Marinella Temprosa, Qing Pan, Mary Foulkes, Nicole Butler, Elizabeth M Venditti, Andrea M Kriska, Linda Semler, Valerie Weinzierl, Santica Marcovina, Greg Strylewicz, John Albers, Ronald J Prineas, Teresa Alexander, Charles Campbell, Sharon Hall, Susan Hensley, Yabing Li, Margaret Mills, Elsayed Soliman, Zhuming Zhang, Ronald Danis, Matthew Davis, Larry Hubbard, Ryan Endres, Deborah Elsas, Samantha Johnson, Vonnie Gama, Anne Goulding, Gregory Evans, Elizabeth Stamm, Jose A Luchsinger, Judith Fradkin, Sanford Garfield, Edward Gregg, Ping Zhang, William H Herman, Morton B Brown, Elizabeth Mayer-Davis, Robert R Moran, Ted Ganiats, Andrew J Sarkin, Naomi Katzir, Erik Groessl, Matthew Budoff, Chris Dailing, Jose C Florez, David Altshuler, Paul I W de Bakker, Paul W Franks, Robert L Hanson, Kathleen Jablonski, William C Knowler, Toni I Pollin, Alan R Shuldiner
Abstract
Aims: Whether long-term cardiovascular risk is reduced by the Diabetes Prevention Program interventions is unknown. The aim of this study was to determine the long-term differences in cardiovascular disease risk factors and the use of lipid and blood pressure medications by the original Diabetes Prevention Program intervention group.
Methods: This long-term follow-up (median 10 years, interquartile range 9.0-10.5) of the three-arm Diabetes Prevention Program randomized controlled clinical trial (metformin, intensive lifestyle and placebo), performed on 2766 (88%) of the Diabetes Prevention Program participants (who originally had impaired glucose tolerance), comprised a mean of 3.2 years of randomized treatment, approximately 1-year transition (during which all participants were offered intensive lifestyle intervention) and 5 years follow-up (Diabetes Prevention Program Outcomes Study). During the study, participants were followed in their original groups with their clinical care being provided by practitioners outside the research setting. The study determined lipoprotein profiles and blood pressure and medication use annually.
Results: After 10 years' follow-up from Diabetes Prevention Program baseline, major reductions were seen for systolic (-2 to -3) and diastolic (-6 to -6.5 mmHg) blood pressure, and for LDL cholesterol (-0.51 to -0.6 mmol/l) and triglycerides (-0.23 to -0.25 mmol/l) in all groups, with no between-group differences. HDL cholesterol also rose significantly (0.14 to 0.15 mmol/l) in all groups. Lipid (P = 0.01) and blood pressure (P = 0.09) medication use, however, were lower for the lifestyle group during the Diabetes Prevention Program Outcomes Study.
Conclusion: Overall, intensive lifestyle intervention achieved, with less medication, a comparable long-term effect on cardiovascular disease risk factors, to that seen in the metformin and placebo groups.
Trial registration: ClinicalTrials.gov NCT00038727.
Conflict of interest statement
Competing interests
TJO has been a consultant for Astra Zeneca. RG has speaker honoraria from Merck, GSK and Daiichi-Sankoyo; research grants from Abbott, GSK and Roche; and is on the Consultant Board of GSK, Daiichi-Sankoyo and Pfizer. MT, EB-C, SF, KM, SM, MM, RR, CS, HS and KW have nothing to declare.
© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
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Source: PubMed