Cited by 254Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementDiabetes Management and Research

The DOI matches its Crossref record; 47 of the 47 references it cites were found in a registry or an index; none of the 31 sources its claims cite is checked for support yet.

]. The Influence of Age on the Effects of Lifestyle Modification and Metformin in Prevention of Diabetes

Open access

Abstract

BACKGROUND: The incidence of type 2 diabetes increases with age. It is unknown whether interventions to prevent diabetes are as effective in elderly persons as in younger adults. METHODS: The Diabetes Prevention Program (DPP) demonstrated that an intensive lifestyle intervention (ILS) or metformin could prevent or delay diabetes. A predefined secondary outcome of DPP was to determine if treatment effects varied by age. RESULTS: At baseline, participants aged 60-85 years were leaner and had the best insulin sensitivity and lowest insulin secretion compared to younger age groups. Diabetes incidence rates did not differ by age in the placebo group, but ILS was more effective with increasing age (6.3, 4.9, and 3.3 cases per 100 person-years, in the 25-44, 45-59, and 60-85 year age groups, respectively; p(trend) =.007). Participants aged 60-85 years had the most weight loss and metabolic equivalent (MET)-hours of physical activity. The metformin group showed a trend toward higher diabetes incidence among older participants (6.7, 7.7, and 9.3 cases per 100 person-years in the 25-44, 45-59, and 60-85 year age groups, respectively; p(trend) =.07); and diabetes risk increased with age (hazard ratio [age 60-85 vs 25-44] 1.63, p =.02), after adjusting for the greater weight loss in the 60-85 year age group. CONCLUSIONS: Lifestyle modification was exceptionally effective in preventing diabetes in older individuals; this finding was largely explained by greater weight loss and physical activity. The limited effectiveness of metformin in older persons may reflect age-related differences in insulin action and secretion. A lifestyle modification program can be recommended for older individuals at high risk for type 2 diabetes.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In the Diabetes Prevention Program, intensive lifestyle intervention (ILS) prevented diabetes more effectively with increasing age, while metformin showed a borderline trend toward reduced effectiveness in older participants. The age-related ILS advantage was largely explained by greater weight loss and physical activity in the 60–85 year group.

Key findings

  • Diabetes incidence in the placebo group did not differ by age (11.0, 10.8, and 10.3 cases per 100 person-years in the 25–44, 45–59, and 60–85 year groups; p = .71).
  • ILS became more effective with increasing age: 6.3, 4.9, and 3.3 cases per 100 person-years in the 25–44, 45–59, and 60–85 year groups, respectively (p trend = .007). The 60–85 vs 25–44 hazard ratio was 0.47 (95% CI, 0.28–0.78) in Model 1, but the age difference disappeared after adjusting for time-dependent weight, calorie intake, and activity (HR, 0.83; 95% CI, 0.46–1.50).
  • Metformin showed a borderline trend toward higher diabetes incidence with age: 6.7, 7.7, and 9.3 cases per 100 person-years in the 25–44, 45–59, and 60–85 year groups (p trend = .07). In Table 4, the 60–85 vs 25–44 hazard ratio was 1.45 (95% CI, 0.98–2.16) in Model 1 and 1.37 (95% CI, 0.87–2.16) in Model 3.
  • Older participants had the most weight loss and physical activity: mean weight change was −6.4 kg in the 60–85 group vs −4.1 kg and −5.0 kg in the younger groups; recreational activity change was 18.7 MET-h/wk vs 4.4 and 5.8 MET-h/wk; 55% vs 33% and 39% reached the 7% weight-loss goal, and 48% vs 34% and 38% reached the 150 min/wk exercise goal.

Methods

  • This was a predefined secondary analysis of the Diabetes Prevention Program, a multicenter randomized controlled trial. Participants were aged ≥25 years with impaired glucose tolerance and fasting plasma glucose 95–125 mg/dL; they were randomized to ILS, metformin 850 mg twice daily, or placebo, and followed for an average of 3.2 years.
  • For this analysis, participants were divided into three age groups: 25–44, 45–59, and 60–85 years. Diabetes was determined by annual oral glucose tolerance testing and semiannual fasting plasma glucose, with confirmation by a second test.
  • Analyses used Kruskal-Wallis tests for baseline characteristics, mixed-effects models for continuous changes, generalized estimating equations for goal attainment, and Cox proportional hazards models for time to diabetes, with linear trend tests and step-down Bonferroni adjustment for pairwise comparisons.

Limitations

  • The paper states that ethnic and sex distributions were unequal across age groups, with men and Caucasians over-represented among older participants; the study had limited power to detect age differences in this predefined secondary outcome; and the DPP cohort was relatively healthy and motivated, excluding individuals with significant physical limitations, so results may not apply to frail or disabled elderly persons.
  • The paper also states that the numbers precluded meaningful stratified analyses to examine the effect of unequal ethnic and sex distributions in some age groups.
  • The text makes evident that age-group comparisons are nonrandomized even though treatment assignment was randomized, so residual confounding by age-related factors cannot be excluded.

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Integrity signals

Registry

Crossref · 10.1093/gerona/61.10.1075

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

48 Own result · 22 Not checked yet · 22 Own interpretation · 13 Own method · 2 No basis given

Verify all 31 references — free account

Show all 66 claims

  • It may state two separate claims as one. 22
  • Probably not a substantial claim. 26
41 of 41
  • The authors state this as an assumption.

    It is unknown whether interventions to prevent diabetes are as effective in elderly persons as in younger adults.

    “It is unknown whether interventions to prevent diabetes are as effective in elderly persons as in younger adults.”
  • The paper relies on this without support.

    The incidence of type 2 diabetes increases with age.

    “The incidence of type 2 diabetes increases with age.”
  • The paper relies on this without support.

    The metabolic defects underlying the development of diabetes and the ability to adhere to lifestyle modification may vary by age and could influence the effectiveness of diabetes prevention in older individuals.

    “The metabolic defects underlying the development of diabetes and the ability to adhere to lifestyle modification may vary by age and could influence the effectiveness of diabetes prevention in older individuals.”
  • The paper relies on this without support.

    The DPP cohort was a relatively healthy and motivated group.

    “As noted, the DPP cohort was a relatively healthy and motivated group”
  • The paper relies on this without support.

    The DPP ILS program was well-tolerated by older participants.

    “On the whole, the DPP ILS program of low-intensity aerobic activity and low-fat, reduced-calorie diet was well-tolerated by older participants”
5 of 5

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1 of 1

Citations

Cites

Show all 46 references

Research works printed but not linked: 4

  1. 2005, Diabetes, 54, 2402
  2. 1997, Medicine and Science in Sports and Exercise, 29, S5
  3. 1979, SCANDINAVIAN J STATISTICS, 6, 65
  4. 1990, American Journal of Physiology -- Legacy Content, 258, E937

Cited by

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Items 201–253 of 253

Metadata

Authors
The Diabetes Prevention Program Research Group [Prepared by Jill Crandall, D. S.
Corresponding author
The Diabetes Prevention Program Research Group [Prepared by Jill Crandall, David Schade, Yong Ma, Wilfred Y. Fujimoto, Elizabeth Barrett-Connor, Sarah Fowler, Sam Dagogo-Jack, Reubin Andres
Venue
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
Published
2006-10-01
Volume
61
Issue
10
Pages
1075-1081
ISSN
  • 1079-5006 (ISSN-L)
  • 1758-535X
OpenAlex
W1508260332
Cited by
254
References
46
Citations by year
2026: 5 · 2025: 5 · 2024: 8 · 2023: 14 · 2022: 7 · 2021: 10 · 2020: 8 · 2019: 11 · 2018: 15 · 2017: 13 · 2016: 15 · 2015: 16 · 2014: 14 · 2013: 15 · 2012: 26
FWCI
10.64
Type
journal article
Language
en
Open access
Locations
  • The Journals of Gerontology Series A (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • American Diabetes Association
  • Bristol-Myers Squibb
  • George Washington University
  • National Institutes of Health
  • Centers for Disease Control and Prevention
  • National Institute on Aging
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01DK048400, U01DK048411, U01DK048489)
  • National Institute of Child Health and Human Development
  • National Center for Research Resources
  • Office of Women's Health
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, age differences, intensive lifestyle intervention, metformin, Diabetes Prevention Program, older adults, weight loss, physical activity, insulin sensitivity, insulin secretion, diabetes incidence
MeSH terms
Adult, Age Factors, Aged, Diabetes Mellitus, Type 2, Female, Glucose, Humans, Hypoglycemic Agents, Life Style, Male, Metformin, Middle Aged, Incidence

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