Exploring residual risk for diabetes and microvascular disease in the Diabetes Prevention Program Outcomes Study (DPPOS)
Open accessAbstract
Aim Approximately half of the participants in the Diabetes Prevention Outcomes Study (DPPOS) had diabetes after 15 years of follow-up, whereas nearly all the others remained with pre-diabetes. We examined whether formerly unexplored factors in the DPPOS coexisted with known risk factors that posed additional risk for, or protection from, diabetes as well as microvascular disease. Methods Cox proportional hazard models were used to examine predictors of diabetes. Sequential modelling procedures considered known and formerly unexplored factors. We also constructed models to determine whether the same unexplored factors that associated with progression to diabetes also predicted the prevalence of microvascular disease. Hazard ratios (HR) are per standard deviation change in the variable. Results In models adjusted for demographics and known diabetes risk factors, two formerly unknown factors were associated with risk for both diabetes and microvascular disease: number of medications taken (HR = 1.07, 95% confidence intervals (95% CI) 1.03 to 1.12 for diabetes; odds ratio (OR) = 1.10, 95% CI 1.04 to 1.16 for microvascular disease) and variability in HbA1c (HR = 1.02, 95% CI 1.01 to 1.03 for diabetes; OR = 1.06, 95% CI 1.04 to 1.09 for microvascular disease per sd). Total comorbidities increased risk for diabetes (HR = 1.10, 95% CI 1.04 to 1.16), whereas higher systolic (OR = 1.22, 95% CI 1.13 to 1.31) and diastolic (OR = 1.14, 95% CI 1.05 to 1.22) blood pressure, as well as the use of anti-hypertensives (OR = 1.41, 95% CI 1.23 to 1.62), increased risk of microvascular disease. Conclusions Several formerly unexplored factors in the DPPOS predicted additional risk for diabetes and/or microvascular disease – particularly hypertension and the use of anti-hypertensive medications – helping to explain some of the residual disease risk in participants of the DPPOS.
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In the most recent NIH DPPOS report, prevention of progression from prediabetes to diabetes resulted in lower rates of developing retinopathy and nephropathy.
“In the most recent National Institutes of Health (NIH) Diabetes Prevention Program Outcomes Study (DPPOS) report, prevention of progression from prediabetes to diabetes (98) resulted in lower rates of developing retinopathy and nephropathy (99).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [98]
The Introduction (page unavailable) says that preventing or delaying diabetes was associated with a lower prevalence of composite microvascular disease after 14–17 years. It does not report that prevention resulted in lower rates of retinopathy and nephropathy separately; it also says treatment-group differences in diabetes rates had not produced corresponding differences in overall microvascular-disease prevalence, except among women in the intensive-lifestyle group. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn the DPPOS report, prevention of progression from prediabetes to diabetes resulted in lower rates of developing retinopathy and nephropathy.
“In the National Institutes of Health (NIH) Diabetes Prevention Program Outcomes Study (DPPOS) report, prevention of progression from prediabetes to diabetes (101) resulted in lower rates of developing retinopathy and nephropathy (102).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [101]
The Introduction (page unavailable) says that preventing or delaying diabetes was associated with a lower prevalence of microvascular disease. It does not establish that prevention resulted in lower rates of retinopathy and nephropathy specifically; it also says the treatment groups’ different diabetes rates did not generally produce corresponding differences in microvascular disease prevalence. (LLM, conf=0.86)
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- Authors
- Perreault, L., Pan, Q., Aroda, V. R., Barrett-Connor, E., Dabelea, D., Dagogo-Jack, S., Hamman, R. F., Kahn, S. E., Mather, K. J., Knowler, W. C., & the Diabetes Prevention Program Research Group
- Affiliations
- University of Colorado; Aurora CO USA
- George Washington University (US)
- MedStar Health Research Institute (US)
- University of California San Diego (US)
- Colorado School of Public Health (US)
- University of Memphis (US)
- University of Washington (US)
- Indiana University Indianapolis (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- ORCID
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2017-09-19
- Volume
- 34
- Issue
- 12
- Pages
- 1747-1755
- ISSN
- 0742-3071 (ISSN-L)
- PMC
- PMC5687994
- OpenAlex
- W2750051511
- Cited by
- 55
- References
- 36
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 11 · 2023: 13 · 2022: 5 · 2021: 5 · 2020: 4 · 2019: 8 · 2018: 1 · 2016: 1
- FWCI
- 2.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Author eBooks
- Funders
- U.S. Department of Health and Human Services
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institutes of Health (5U01-DK048375-12)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- residual risk, diabetes mellitus, microangiopathy, Diabetes Prevention Program Outcomes Study, prediabetes, medication burden, HbA1c variability, comorbidities, hypertension, antihypertensive drugs, blood pressure, disease progression
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Diet, Reducing, Exercise Therapy, Female, Follow-Up Studies, Humans, Male, Metformin, Middle Aged, Obesity, Prediabetic State, Risk Factors, Prevalence, Treatment Outcome, Risk Reduction Behavior, Overweight, Weight Reduction Programs
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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