The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program outcomes study 10-year follow-up
V R Aroda, C A Christophi, S L Edelstein, P Zhang, W H Herman, E Barrett-Connor, L M Delahanty, M G Montez, R T Ackermann, X Zhuo, W C Knowler, R E Ratner, Diabetes Prevention Program Research Group, Annie Chatellier, Jennifer Arceneaux, Amber Dragg, Crystal Duncan, Frank L Greenway, Erma Levy, Donna H Ryan, David Ehrmann, Margaret J Matulik, Kirsten Czech, Catherine DeSandre, 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, Kathy Hattaway, Carlos Lorenzo, Arlene Martinez, Tatiana Walker, Richard F Hamman, Dana Dabelea, Lisa Testaverde, Denise Anderson, Alexis Bouffard, Tonya Jenkins, Dione Lenz, Leigh Perreault, David W Price, Sheila C Steinke, Edward S Horton, Catherine S Poirier, Kati Swift, Enrique Caballero, Barbara Fargnoli, Ashley Guidi, Mathew Guido, Sharon D Jackson, Lori Lambert, Kathleen E Lawton, Sarah Ledbury, Jessica Sansoucy, Jeanne Spellman, Steven E Kahn, Brenda K Montgomery, Wilfred Fujimoto, Robert H Knopp, Edward W Lipkin, Ivy Morgan-Taggart, Anne Murillo, Lonnese Taylor, April Thomas, Elaine C Tsai, Dace Trence, Abbas E Kitabchi, Samuel Dagogo-Jack, Mary E Murphy, Laura Taylor, Jennifer Dolgoff, Debra Clark, Uzoma Ibebuogu, Helen Lambeth, Harriet Ricks, Lily M K Rutledge, Judith E Soberman, Mark E Molitch, Boyd E Metzger, Mariana K Johnson, Mimi M Giles, Diane Larsen, Samsam C Pen, David M Nathan, Mary Larkin, Charles McKitrick, Heather Turgeon, Ellen Anderson, Laurie Bissett, Kristy Bondi, Enrico Cagliero, Kali D'Anna, Linda Delahanty, Jose C Florez, Valerie Goldman, Peter Lou, Alexandra Poulos, Elyse Raymond, Christine Stevens, Beverly Tseng, Elizabeth Barrett-Connor, Mary Lou Carrion-Petersen, Lauren N Claravall, Jonalle M Dowden, Javiva Horne, Diana Leos, Sundar Mudaliar, Jean Smith, Simona Szerdi Janisch, Karen Vejvoda, F Xavier Pi-Sunyer, Jane E Lee, Sandra T Foo, Susan Hagamen, David G Marrero, Kieren J Mather, Susie M Kelly, Paula Putenney, Marcia A Jackson, Gina McAtee, Ronald T Ackermann, Carolyn M Cantrell, Edwin S Fineberg, Angela Hadden, Marion S Kirkman, Paris J Roach, Robert E Ratner, Vanita Aroda, Sue Shapiro, Catherine Bavido-Arrage, Lilia Leon, Peggy Gibbs, Gabriel Uwaifo, Debra Wells-Thayer, Renee Wiggins, Mohammed F Saad, Karol Watson, Medhat Botrous, Sujata Jinagouda, Maria Budget, Claudia Conzues, Perpetua Magpuri, Kathy Ngo, Kathy Xapthalamous, Neil H White, Angela L Brown, Samia Das, Prajakta Khare-Ranade, Tamara Stich, Ana Santiago, Cormarie Wernimont, Christopher D Saudek, Sherita Hill Golden, Tracy Whittington, Frederick L Brancati, 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, Janene L Canady, Kathleen Colleran, Ysela Gonzales, Doris A Hernandez-McGinnis, Carolyn King, Jill Crandall, Janet O Brown, Gilda Trandafirescu, Elsie Adorno, Helena Duffy, Angela Goldstein, Jennifer Lukin, Helen Martinez, Dorothy Pompi, Harry Shamoon, Jonathan Scheindlin, Elizabeth A Walker, Judith Wylie-Rosett, Trevor Orchard, Andrea Kriska, Susan Jeffries, M Kaye Kramer, Marie Smith, Catherine Benchoff, Stephanie Guimond, Jessica Pettigrew, Debra Rubinstein, 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, Alvera Enote, Mary A Hoskin, Camille Natewa, Carol A Percy, Kelly J Acton, Vickie L Andre, Roz Barber, Shandiin Begay, Brian C Bucca, Sherron Cook, Jeff Curtis, Charlotte Dodge, Matthew S Doughty, Justin Glass, Martia Glass, Robert L Hanson, Louise E Ingraham, Kathleen M Kobus, Jonathan Krakoff, Catherine Manus, Cherie McCabe, Sara Michaels, Tina Morgan, Julie A Nelson, Christopher Piromalli, Robert J Roy, Sandra Sangster, Miranda Smart, Darryl P Tonemah, Rachel Williams, Charlton Wilson, Sarah Fowler, Marinella Temprosa, Michael D Larsen, Tina Brenneman, Hanna Sherif, Sharon L Edelstein, Solome Abebe, Julie Bamdad, Melanie Barkalow, Joel Bethepu, Tsedenia Bezabeh, Nicole Butler, Jackie Callaghan, Costas Christophi, Gregory Dwyer, Mary Foulkes, Yuping Gao, Robert Gooding, Adrienne Gottlieb, Nisha Grover, Heather Hoffman, Kathleen Jablonski, Richard Katz, Preethy Kolinjivadi, John M Lachin, Yong Ma, Qing Pan, Susan Reamer, Alla Sapozhnikova, Elizabeth M Venditti, Andrea M Kriska, Linda Semler, Valerie Weinzierl, Santica Marcovina, Greg Strylewicz, John Albers, V R Aroda, C A Christophi, S L Edelstein, P Zhang, W H Herman, E Barrett-Connor, L M Delahanty, M G Montez, R T Ackermann, X Zhuo, W C Knowler, R E Ratner, Diabetes Prevention Program Research Group, Annie Chatellier, Jennifer Arceneaux, Amber Dragg, Crystal Duncan, Frank L Greenway, Erma Levy, Donna H Ryan, David Ehrmann, Margaret J Matulik, Kirsten Czech, Catherine DeSandre, 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, Kathy Hattaway, Carlos Lorenzo, Arlene Martinez, Tatiana Walker, Richard F Hamman, Dana Dabelea, Lisa Testaverde, Denise Anderson, Alexis Bouffard, Tonya Jenkins, Dione Lenz, Leigh Perreault, David W Price, Sheila C Steinke, Edward S Horton, Catherine S Poirier, Kati Swift, Enrique Caballero, Barbara Fargnoli, Ashley Guidi, Mathew Guido, Sharon D Jackson, Lori Lambert, Kathleen E Lawton, Sarah Ledbury, Jessica Sansoucy, Jeanne Spellman, Steven E Kahn, Brenda K Montgomery, Wilfred Fujimoto, Robert H Knopp, Edward W Lipkin, Ivy Morgan-Taggart, Anne Murillo, Lonnese Taylor, April Thomas, Elaine C Tsai, Dace Trence, Abbas E Kitabchi, Samuel Dagogo-Jack, Mary E Murphy, Laura Taylor, Jennifer Dolgoff, Debra Clark, Uzoma Ibebuogu, Helen Lambeth, Harriet Ricks, Lily M K Rutledge, Judith E Soberman, Mark E Molitch, Boyd E Metzger, Mariana K Johnson, Mimi M Giles, Diane Larsen, Samsam C Pen, David M Nathan, Mary Larkin, Charles McKitrick, Heather Turgeon, Ellen Anderson, Laurie Bissett, Kristy Bondi, Enrico Cagliero, Kali D'Anna, Linda Delahanty, Jose C Florez, Valerie Goldman, Peter Lou, Alexandra Poulos, Elyse Raymond, Christine Stevens, Beverly Tseng, Elizabeth Barrett-Connor, Mary Lou Carrion-Petersen, Lauren N Claravall, Jonalle M Dowden, Javiva Horne, Diana Leos, Sundar Mudaliar, Jean Smith, Simona Szerdi Janisch, Karen Vejvoda, F Xavier Pi-Sunyer, Jane E Lee, Sandra T Foo, Susan Hagamen, David G Marrero, Kieren J Mather, Susie M Kelly, Paula Putenney, Marcia A Jackson, Gina McAtee, Ronald T Ackermann, Carolyn M Cantrell, Edwin S Fineberg, Angela Hadden, Marion S Kirkman, Paris J Roach, Robert E Ratner, Vanita Aroda, Sue Shapiro, Catherine Bavido-Arrage, Lilia Leon, Peggy Gibbs, Gabriel Uwaifo, Debra Wells-Thayer, Renee Wiggins, Mohammed F Saad, Karol Watson, Medhat Botrous, Sujata Jinagouda, Maria Budget, Claudia Conzues, Perpetua Magpuri, Kathy Ngo, Kathy Xapthalamous, Neil H White, Angela L Brown, Samia Das, Prajakta Khare-Ranade, Tamara Stich, Ana Santiago, Cormarie Wernimont, Christopher D Saudek, Sherita Hill Golden, Tracy Whittington, Frederick L Brancati, 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, Janene L Canady, Kathleen Colleran, Ysela Gonzales, Doris A Hernandez-McGinnis, Carolyn King, Jill Crandall, Janet O Brown, Gilda Trandafirescu, Elsie Adorno, Helena Duffy, Angela Goldstein, Jennifer Lukin, Helen Martinez, Dorothy Pompi, Harry Shamoon, Jonathan Scheindlin, Elizabeth A Walker, Judith Wylie-Rosett, Trevor Orchard, Andrea Kriska, Susan Jeffries, M Kaye Kramer, Marie Smith, Catherine Benchoff, Stephanie Guimond, Jessica Pettigrew, Debra Rubinstein, 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, Alvera Enote, Mary A Hoskin, Camille Natewa, Carol A Percy, Kelly J Acton, Vickie L Andre, Roz Barber, Shandiin Begay, Brian C Bucca, Sherron Cook, Jeff Curtis, Charlotte Dodge, Matthew S Doughty, Justin Glass, Martia Glass, Robert L Hanson, Louise E Ingraham, Kathleen M Kobus, Jonathan Krakoff, Catherine Manus, Cherie McCabe, Sara Michaels, Tina Morgan, Julie A Nelson, Christopher Piromalli, Robert J Roy, Sandra Sangster, Miranda Smart, Darryl P Tonemah, Rachel Williams, Charlton Wilson, Sarah Fowler, Marinella Temprosa, Michael D Larsen, Tina Brenneman, Hanna Sherif, Sharon L Edelstein, Solome Abebe, Julie Bamdad, Melanie Barkalow, Joel Bethepu, Tsedenia Bezabeh, Nicole Butler, Jackie Callaghan, Costas Christophi, Gregory Dwyer, Mary Foulkes, Yuping Gao, Robert Gooding, Adrienne Gottlieb, Nisha Grover, Heather Hoffman, Kathleen Jablonski, Richard Katz, Preethy Kolinjivadi, John M Lachin, Yong Ma, Qing Pan, Susan Reamer, Alla Sapozhnikova, Elizabeth M Venditti, Andrea M Kriska, Linda Semler, Valerie Weinzierl, Santica Marcovina, Greg Strylewicz, John Albers
Abstract
Context: Gestational diabetes (GDM) confers a high risk of type 2 diabetes. In the Diabetes Prevention Program (DPP), intensive lifestyle (ILS) and metformin prevented or delayed diabetes in women with a history of GDM.
Objective: The objective of the study was to evaluate the impact of ILS and metformin intervention over 10 years in women with and without a history of GDM in the DPP/Diabetes Prevention Program Outcomes Study.
Design: This was a randomized controlled clinical trial with an observational follow-up.
Setting: The study was conducted at 27 clinical centers.
Participants: Three hundred fifty women with a history of GDM and 1416 women with previous live births but no history of GDM participated in the study. The participants had an elevated body mass index and fasting glucose and impaired glucose tolerance at study entry.
Interventions: Interventions included placebo, ILS, or metformin.
Outcomes measure: Outcomes measure was diabetes mellitus.
Results: Over 10 years, women with a history of GDM assigned to placebo had a 48% higher risk of developing diabetes compared with women without a history of GDM. In women with a history of GDM, ILS and metformin reduced progression to diabetes compared with placebo by 35% and 40%, respectively. Among women without a history of GDM, ILS reduced the progression to diabetes by 30%, and metformin did not reduce the progression to diabetes.
Conclusions: Women with a history of GDM are at an increased risk of developing diabetes. In women with a history of GDM in the DPP/Diabetes Prevention Program Outcomes Study, both lifestyle and metformin were highly effective in reducing progression to diabetes during a 10-year follow-up period. Among women without a history of GDM, lifestyle but not metformin reduced progression to diabetes.
Trial registration: ClinicalTrials.gov NCT00004992 NCT00038727.
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Source: PubMed