Managing CMR

Preventing Type 2 Diabetes

Targeting Abdominal Obesity

Lifestyle Interventions

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Using a similar approach, the Diabetes Prevention Program randomly assigned 3,234 participants with IGT to a placebo with standard lifestyle recommendations, the antihyperglycemic agent metformin with standard lifestyle recommendations, or a lifestyle modification program designed to achieve and maintain a 7% body weight reduction (9). During the 4 year follow-up, diabetes incidence dropped by 58% and 31% for the lifestyle and metformin groups respectively, as compared to the placebo (Figure 2). Compared to the metformin group, a greater number of subjects in the lifestyle group had normal post-load glucose values at the end of the follow-up. Similarly, compared to the placebo, the lifestyle group experienced a 41% reduction in metabolic syndrome incidence and the metformin group experienced a 17% reduction. Among features of the metabolic syndrome, both intervention groups saw their HDL cholesterol levels rise and their waist circumference and fasting glucose levels improve. However, only the lifestyle intervention group experienced a decrease in triglyceride levels and blood pressure (10).

In the Indian Diabetes Prevention Programme (IDPP-1), Ramachadran et al. (11) tested the effect of lifestyle intervention and metformin treatment on reducing the onset of diabetes in native Asian Indians with IGT. They randomized 531 subjects in four groups: 1- a control group, 2- lifestyle modifications, 3- treatment with metformin, and 4- lifestyle modifications and treatment with metformin. The 3 year cumulative incidences of diabetes for the four groups were 55.0%, 39.3%, 40.5%, and 39.5% respectively. The authors concluded that both lifestyle modifications and metformin treatment reduced the risk of diabetes and that there were no additional benefits to combining both treatments.

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9. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403.
10. Orchard TJ, Temprosa M, Goldberg R, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med 2005; 142: 611-9.
11. Ramachandran A, Snehalatha C, Mary S, et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006; 49: 289-97.