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)

Ramachandran, A.; Snehalatha, C.; Mary, S.; Mukesh, B.; Bhaskar, A. D.; Vijay, V.; Indian Diabetes Prevention Programme (IDPP)

doi:10.1007/s00125-005-0097-z

Cited by 1,881Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementDiabetes Management and Research

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)

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Ramachandran, A., Snehalatha, C., Mary, S., Mukesh, B., Bhaskar, A. D., Vijay, V., Indian Diabetes Prevention Programme (IDPP)·2006·Diabetologia

DOI 10.1007/s00125-005-0097-z

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Abstract

Aims/hypothesis Lifestyle modification helps in the primary prevention of diabetes in multiethnic American, Finnish and Chinese populations. In a prospective community-based study, we tested whether the progression to diabetes could be influenced by interventions in native Asian Indians with IGT who were younger, leaner and more insulin resistant than the above populations.Methods We randomised 531 (421 men 110 women) subjects with IGT (mean age 45.9+/-5.7 years, BMI 25.8+/-3.5 kg/m(2)) into four groups. Group 1 was the control, Group 2 was given advice on lifestyle modification (LSM), Group 3 was treated with metformin (MET) and Group 4 was given LSM plus MET. The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria.Results The median follow-up period was 30 months, and the 3-year cumulative incidences of diabetes were 55.0%, 39.3%, 40.5% and 39.5% in Groups 1-4, respectively. The relative risk reduction was 28.5% with LSM (95% CI 20.5-37.3, p=0.018), 26.4% with MET (95% CI 19.1-35.1, p=0.029) and 28.2% with LSM + MET (95% CI 20.3-37.0, p=0.022), as compared with the control group. The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM, 6.9 for MET and 6.5 for LSM + MET.Conclusions/interpretation Progression of IGT to diabetes is high in native Asian Indians. Both LSM and MET significantly reduced the incidence of diabetes in Asian Indians with IGT; there was no added benefit from combining them.

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In people with prior prediabetes or gestational diabetes, metformin lowered weight and BMI.
“The Indian and US Diabetes Prevention studies, conducted in people with prior prediabetes or gestational diabetes mellitus (GDM) and likely to include many women with PCOS, reported that metformin lowered weight and BMI and reduced progression to DM2 (Knowler et al. , 2002; Ramachandran et al. , 2006), with metformin more effective for women with prior GDM (Ratner et al. , 2008).”
From Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis (2015) · cites this paper as Ramachandran et al. , 2006
The Discussion says the IDPP subjects did not lose weight. The Results report no significant change in body weight from baseline in the metformin group; the paper does not report that metformin lowered BMI or establish this outcome in people with prior GDM. It does report reduced progression from impaired glucose tolerance to diabetes. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
The DPP and other clinical trials have established the feasibility of interrupting the worsening of hyperglycaemia in overweight people with raised fasting or postload glycaemia.
“The DPP and other clinical trials12–16 have established the feasibility of interruption of the worsening of hyperglycaemia in overweight people who have raised fasting or postload glycaemia.”
From 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study (2009) · cites this paper as [16]
The Discussion reports that lifestyle modification and metformin reduced progression from impaired glucose tolerance to diabetes in native Asian Indian subjects, supporting the feasibility claim for people with raised postload glucose. The Population and recruitment section defines that glucose criterion, but the trial did not require participants to be overweight; the Discussion gives a mean BMI of 25.8, not an overweight-only result. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Five clinical trials of reputedly healthy, energy-restricted diets plus increased physical activity in individuals with impaired glucose tolerance showed risk reductions between 30 and 70%.
“Five clinical trials that examined the effects of reputedly healthy, energy-restricted diets together with increased physical activity in individuals with impaired glucose tolerance, a prediabetic stage, showed risk reductions between 30 and 70% ( 2 – 6 ).”
From Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet (2011) · cites this paper as [6]
The Population and recruitment section describes advice to reduce calories and increase physical activity for participants with impaired glucose tolerance. The Discussion’s Table 3 reports a 28.5% relative risk reduction for lifestyle modification—just below the claimed 30–70% range. The Introduction identifies four earlier lifestyle trials, but this paper does not establish that all five achieved reductions within that range. (LLM, conf=0.87)
Experimental — accuracy not yet measured
In people with prior prediabetes or gestational diabetes, metformin reduced progression to type 2 diabetes.
“The Indian and US Diabetes Prevention studies, conducted in people with prior prediabetes or gestational diabetes mellitus (GDM) and likely to include many women with PCOS, reported that metformin lowered weight and BMI and reduced progression to DM2 (Knowler et al. , 2002; Ramachandran et al. , 2006), with metformin more effective for women with prior GDM (Ratner et al. , 2008).”
From Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis (2015) · cites this paper as Ramachandran et al. , 2006
Table 3 (Discussion; page unavailable) reports lower three-year diabetes incidence with metformin than with control among Asian Indian participants with impaired glucose tolerance. The citing sentence also attributes lower weight and BMI to this study, but the Results report no significant weight decrease in the metformin group. The study does not establish the result for people with prior gestational diabetes. (LLM, conf=0.89)
Experimental — accuracy not yet measured
Lifestyle modification has been proven to prevent or at least delay type 2 diabetes and its complications in large randomized trials.
“lifestyle modification (LSM) has been proven to prevent or at least delay type 2 diabetes and its complications in large randomized trials (2–6)”
From Global diabetes prevention interventions: A systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose (2018) · cites this paper as [3]
The Introduction (page unavailable) says randomized studies found that lifestyle modification delays or prevents progression to diabetes, and the Discussion reports lower diabetes incidence in this trial’s lifestyle group than in controls. The paper does not report that lifestyle modification prevents or delays diabetes complications; its measured outcome was diabetes onset. (LLM, conf=0.88)
Experimental — accuracy not yet measured

In countries with universal health insurance and good access to primary care, people at high risk of diabetes might be identified early and advised to use a combination of diet and lifestyle modifications and medicines to prevent or delay diabetes onset.
“In countries with universal health insurance and good access to primary care, people at a high risk of diabetes might also be identified early and advised to use a combination of diet and lifestyle modifications and medicines to prevent or delay diabetes onset.48–55”
From Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants (2024) · cites this paper as [50]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Diet and lifestyle modification and medicines in people at high risk of diabetes (including those with prediabetes) can prevent or delay diabetes onset and reduce the risk of some complications.
“Alongside these population-based measures, diet and lifestyle modification and medicines in people at a high risk of diabetes (including those with prediabetes) can prevent or delay diabetes onset and reduce the risk of some complications.48–55”
From Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants (2024) · cites this paper as [50]
The Results report lower diabetes incidence with lifestyle modification and metformin than with control treatment in Asian Indian subjects with impaired glucose tolerance. The paper does not establish that these interventions reduce complications: its primary outcome was diabetes onset, and the Adverse events section reports cardiovascular events without showing a reduction. (LLM, conf=0.89)
Experimental — accuracy not yet measured
In four of the five clinical trials, diabetes rates decreased in relation to substantial reductions in body weight, whereas in the Indian trial lifestyle intervention was successful despite no weight loss.
“In four of these studies ( 2 – 5 ), diabetes rates decreased in relation to substantial reductions in body weight, whereas in the Indian trial ( 6 ) lifestyle intervention was successful despite no weight loss.”
From Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet (2011) · cites this paper as [6]
Lifestyle modification reduces the incidence of diabetes among high-risk individuals.
“The results of these studies provide convincing evidence that lifestyle modification reduces the incidence of diabetes among high-risk individuals.”
From Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet (2011) · cites this paper as [6]
PA seems to play a role in preventing type 2 diabetes across ethnic groups and in both sexes.
“PA seems to play a role in preventing type 2 diabetes across ethnic groups and in both sexes”
From Exercise and Type 2 Diabetes (2010) · cites this paper as [224]
Although interventions can clearly reduce diabetes incidence over a period of a few years, it is not well known how long their effects persist, especially when interventions cease or become less intensive.
“Although interventions can clearly reduce diabetes incidence over a period of a few years,1–5 it is not well known how long their effects persist, especially when interventions cease or become less intensive.”
From Long-term effects and effect heterogeneity of lifestyle and metformin interventions on type 2 diabetes incidence over 21 years in the US Diabetes Prevention Program randomised clinical trial (2025) · cites this paper as [4]
Several trials have demonstrated reductions in the risk of developing diabetes among prediabetic individuals after lifestyle and drug-based interventions.
“Several trials have demonstrated reductions in the risk of developing diabetes among prediabetic individuals after lifestyle and drug-based interventions.15,24–28”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [26]
The beneficial effect of lifestyle interventions has also been confirmed among Asian populations.
“The beneficial effect of lifestyle interventions has also been confirmed among Asian populations.26,91”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [26]
Metformin's effect was similar to lifestyle intervention in the Indian DPP-1 study, while in the US DPP it was less effective than lifestyle.
“Its effect was similar to lifestyle intervention in the Indian DPP-1 study,26 while in the US DPP it was less effective than lifestyle.25”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [26]
Gastrointestinal side effects of metformin were mostly mild to moderate, so the intervention seemed to be safe.
“Gastrointestinal side effects of the drug were mostly mild to moderate, so the intervention seemed to be safe.25,26”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [26]
The increased prevalence of insulin resistance in Asian-Indian men may explain the lower efficacy of lifestyle intervention in the Indian diabetes prevention study compared with the U.S. and Finnish diabetes prevention studies.
“which may have important therapeutic implications for prevention and treatment of T2DM in this ethnic group and possibly explain the lower efficacy of lifestyle intervention in the Indian diabetes prevention study compared with the U.S. and Finnish diabetes prevention studies (33-35).”
From Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian-Indian men (2006) · cites this paper as [35]
In the Indian Diabetes Prevention Program, after 3 years of follow-up, the RR reduction was 28.5% with lifestyle management, 26.4% with metformin, and 28.2% with the combined interventions compared with the control group.
“In the Indian Diabetes Prevention Program (IDPP) (63), after 3 years of follow-up, the RR reduction was 28.5% with lifestyle management, 26.4% with metformin, and 28.2% with the combined interventions compared with the control group.”
From Globalization of Diabetes (2011) · cites this paper as [63]
In an Indian population with impaired glucose tolerance, metformin significantly reduced the risk of developing diabetes (relative risk reduction 26.4%, p=0.029) compared with control.
“The relative risk reduction was 28.5% with lifestyle modification (p = 0.018), 26.4% with metformin (p = 0.029), and 28.2% with lifestyle modification plus metformin (p = 0.022), as compared with the control group [9] (Table 1).”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [9]
In the Indian Diabetes Prevention Programme, metformin 250 mg twice daily reduced incident diabetes by 28% in IGT.
“In the Indian Diabetes Prevention Programme metformin 250 mg twice a day reduced incident diabetes by 28% in IGT.191”
From The Vasculature in Prediabetes (2018) · cites this paper as [191]
In the Indian Diabetes Prevention Programme, combined metformin and lifestyle modification had no added benefit.
“There was no added benefit of combined metformin and lifestyle modification.”
From The Vasculature in Prediabetes (2018) · cites this paper as [191]
Similar effects of diet and exercise were seen in men in the Japanese IGT study and in the Indian Diabetes Prevention Programme in patients with IGT.
“Similar effects of diet and exercise were seen in men in the Japanese IGT study and in the Indian Diabetes Prevention Programme in patients with IGT.”
From The Vasculature in Prediabetes (2018) · cites this paper as [191]
The efficacy of interventions for primary prevention of type 2 diabetes has primarily been demonstrated among individuals with IGT, not individuals with IFG who do not also have IGT.
“The efficacy of interventions for primary prevention of type 2 diabetes (10–16) has primarily been demonstrated among individuals with IGT, not individuals with IFG (who do not also have IGT).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [16]
Randomized controlled trials have shown that individuals at high risk for developing diabetes (those with IFG, IGT, or both) can be given interventions that significantly decrease the rate of onset of diabetes.
“Randomized controlled trials have shown that individuals at high risk for developing diabetes (those with IFG, IGT, or both) can be given interventions that significantly decrease the rate of onset of diabetes (10–16).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [16]
Intensive lifestyle modification programs have been shown to be very effective (≥58% reduction after 3 years) in decreasing incident diabetes.
“These interventions include intensive lifestyle modification programs that have been shown to be very effective (≥58% reduction after 3 years) and use of the pharmacologic agents metformin, acarbose, orlistat, and thiazolidinediones (TZDs), each of which has been shown to decrease incident diabetes to various degrees.”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [16]
Metformin, acarbose, orlistat, and thiazolidinediones each have been shown to decrease incident diabetes to various degrees.
“These interventions include intensive lifestyle modification programs that have been shown to be very effective (≥58% reduction after 3 years) and use of the pharmacologic agents metformin, acarbose, orlistat, and thiazolidinediones (TZDs), each of which has been shown to decrease incident diabetes to various degrees.”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [16]

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Authors: Ramachandran, A., Snehalatha, C., Mary, S., Mukesh, B., Bhaskar, A. D., Vijay, V., & Indian Diabetes Prevention Programme (IDPP)
Affiliations: M.V. Hospital for Diabetes and Diabetes Research Centre (IN)
Corresponding author: Ramachandran, A.
ORCID: Ramachandran, A.
Venue: Diabetologia
Publisher: Springer Science and Business Media LLC
Published: 2006-01-04
Volume: 49
Issue: 2
Pages: 289-297
ISSN: 0012-186X (ISSN-L)
1432-0428
DOI: 10.1007/s00125-005-0097-z
OpenAlex: W2006625394
Semantic Scholar: 131ea8c840219222323908f8f07a6cc20cf6f839
Cited by: 1,881
References: 15
Citations by year: 2026: 41 · 2025: 77 · 2024: 76 · 2023: 76 · 2022: 89 · 2021: 89 · 2020: 91 · 2019: 83 · 2018: 111 · 2017: 97 · 2016: 120 · 2015: 115 · 2014: 87 · 2013: 112 · 2012: 102
FWCI: 62.08
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Diabetologia (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords: type 2 diabetes prevention, impaired glucose tolerance, lifestyle modification, metformin, Asian Indians, primary prevention, diabetes incidence, insulin resistance, number needed to treat
MeSH terms: Adult, Combined Modality Therapy, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, India, Life Style, Male, Metformin, Middle Aged, Prospective Studies, Incidence, Proportional Hazards Models, Glucose Intolerance, Disease Progression, Asian People

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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)

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