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Cited by 572Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementBlood Pressure and Hypertension Studies

Impact of Intensive Lifestyle and Metformin Therapy on Cardiovascular Disease Risk Factors in the Diabetes Prevention Program

Open access
The Diabetes Prevention Program Research Group·2005·Diabetes Care
DOI 10.2337/diacare.28.4.888PMC PMC1307521
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Abstract

OBJECTIVE—The Diabetes Prevention Program demonstrated the ability to delay or prevent type 2 diabetes in participants with impaired glucose tolerance (IGT). Participants with IGT are at high risk for cardiovascular disease (CVD), with a marked increase in the number and severity of CVD risk factors. We prospectively assessed the impact of our interventions on hypertension, dyslipidemia, and CVD events. RESEARCH DESIGN AND METHODS—The study group consisted of 3,234 individuals with IGT randomly assigned to receive intensive lifestyle intervention, metformin, or placebo. Annual assessment of blood pressure, lipids, electrocardiogram, and CVD events was undertaken. RESULTS—Hypertension was present in 30% of participants at study entry and then increased in the placebo and metformin groups, although it significantly decreased with intensive lifestyle intervention. Triglyceride levels fell in all treatment groups, but fell significantly more with intensive lifestyle intervention. Total cholesterol and LDL cholesterol levels were similar among treatment groups. Intensive lifestyle intervention significantly increased the HDL cholesterol level and reduced the cumulative incidence of the proatherogenic LDL phenotype B. At 3 years of follow-up, the use for pharmacologic therapy to achieve established goals in the intensive lifestyle group was 27–28% less for hypertension and 25% less for hyperlipidemia compared with placebo and metformin groups. Over an average of 3 years, 89 CVD events from 64 participants were positively adjudicated studywide, with no differences among treatment groups. CONCLUSIONS—Lifestyle intervention improves CVD risk factor status compared with placebo and metformin therapy. Although no differences in CVD events were noted after 3 years, achieved risk factor modifications suggest that longer intervention may reduce CVD event rates.

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Crossref · 10.2337/diacare.28.4.888

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  • Intensive Behavioral Counseling (IBC) interventions like the National Diabetes Prevention Program (NDPP) have demonstrated effectiveness in reducing excess body weight and lowering or delaying morbidity onset.

    “Intensive Behavioral Counseling (IBC) interventions like the National Diabetes Prevention Program (NDPP), have demonstrated effectiveness in reducing excess body weight and lowering or delaying morbidity onset.”

    From Clinical and Economic Impact of a Digital, Remotely-Delivered Intensive Behavioral Counseling Program on Medicare Beneficiaries at Risk for Diabetes and Cardiovascular Disease (2016) · cites this paper as [4]

    The Introduction says the Diabetes Prevention Program delayed or prevented type 2 diabetes in participants with impaired glucose tolerance. Research Design and Methods describes a weight-reduction goal, not a demonstrated weight-loss result; the paper does not assess the National Diabetes Prevention Program specifically. The Results also found no difference in cardiovascular event rates between groups, so it does not establish reduced cardiovascular morbidity. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • IBC has been widely accepted as an effective approach for compliant individuals to reduce body weight, improve clinical measures, and lower risk of obesity-related comorbidities.

    “Intensive Behavioral Counseling (IBC) has been widely accepted as an effective approach for compliant individuals to reduce body weight, improve clinical measures, and lower risk of obesity-related comorbidities [1–6].”

    From Clinical and Economic Impact of a Digital, Remotely-Delivered Intensive Behavioral Counseling Program on Medicare Beneficiaries at Risk for Diabetes and Cardiovascular Disease (2016) · cites this paper as [4]

    The Research Design and Methods section describes an intensive lifestyle program with a weight-loss goal, and the Results report improvements in blood pressure and lipid risk factors among participants with impaired glucose tolerance. The paper does not report achieved weight loss or establish that intensive behavioral counseling is widely accepted specifically for compliant individuals. It also found no significant reduction in cardiovascular events during the study. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Previous work has found that IBC intervention, including NDPP, among overweight and obese adults with prediabetes and CVD risk factors can improve clinical measures, prevent or delay disease onset, reduce medical expenditures, and increase productivity.

    “Previous work has found that IBC intervention, including NDPP, among overweight and obese adults with prediabetes and CVD risk factors can improve clinical measures, prevent or delay disease onset, reduce medical expenditures, and increase productivity (in the form of higher labor force participation and lower work absenteeism) [1–6,13–15,19].”

    From Clinical and Economic Impact of a Digital, Remotely-Delivered Intensive Behavioral Counseling Program on Medicare Beneficiaries at Risk for Diabetes and Cardiovascular Disease (2016) · cites this paper as [4]

    The Introduction reports that the DPP delayed or prevented type 2 diabetes, and the Results report improvements in cardiovascular risk factors with intensive lifestyle intervention (page numbers unavailable). The paper studies the DPP, not the NDPP, and the passages do not support reduced medical expenditures or increased labor-force participation or reduced absenteeism. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • The Diabetes Prevention Program was favorably compared against first-line pharmacotherapy for type 2 diabetes mellitus.

    “and was favorably compared against first-line pharmacotherapy for T2DM [29].”

    From Therapeutic Lifestyle Intervention Targeting Enhanced Cardiometabolic Health and Function for Persons with Chronic Spinal Cord Injury in Caregiver/Care-Receiver Co-Treatment: A Study Protocol of a Multisite Randomized Controlled Trial (2023) · cites this paper as [29]

    The Research Design and Methods section compares intensive lifestyle intervention with metformin in participants with impaired glucose tolerance, and the Results report more favorable cardiovascular risk factors in the lifestyle group. The paper does not identify metformin as first-line pharmacotherapy or test treatment of people with established type 2 diabetes; its comparison concerns diabetes prevention and cardiovascular risk factors. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Weight loss and exercise improve coincident cardiovascular disease risk factors, such as blood pressure and atherogenic lipid profiles, and ameliorate other consequences of obesity.

    “In addition to the beneficial effects of weight loss on glycemia, weight loss and exercise improve coincident CVD risk factors, such as blood pressure and atherogenic lipid profiles, and ameliorate other consequences of obesity (41,46,47).”

    From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [46]

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Cites

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Research works printed but not linked: 2

  1. Hainline A Jr, Karon J, Lippel K (Eds.): Manual of Laboratory Operations. 2nd ed. Bethesda, MD, Lipid Research Clinics Program, Lipid and Lipoprotein Analysis, U.S. Department of Health and Human Service, National Institutes of Health, 1983
  2. Diggle PJ, Liang K-Y, Zeger SL: Analysis of Longitudinal Data. New York, Oxford Uni- versity Press, 1994

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Authors
The Diabetes Prevention Program Research Group
Affiliations
George Washington University (US)
Corresponding author
The Diabetes Prevention Program Research Group
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2005-04-01
Volume
28
Issue
4
Pages
888-894
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.28.4.888
PMC
PMC1307521
OpenAlex
W39653778
Cited by
572
References
41
Citations by year
2026: 6 · 2025: 10 · 2024: 10 · 2023: 13 · 2022: 12 · 2021: 21 · 2020: 14 · 2019: 16 · 2018: 23 · 2017: 29 · 2016: 26 · 2015: 26 · 2014: 45 · 2013: 38 · 2012: 28
FWCI
26.28
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • American Diabetes Association
  • Bristol-Myers Squibb
  • National Institutes of Health
  • Centers for Disease Control and Prevention
  • National Institute on Aging
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01DK048489)
  • National Institute of Child Health and Human Development
  • National Center for Research Resources
  • NIH Clinical Center
  • 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 › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
type 2 diabetes prevention, impaired glucose tolerance, intensive lifestyle intervention, metformin, cardiovascular risk factors, hypertension, dyslipidemia, HDL cholesterol, triglycerides, cardiovascular events, Diabetes Prevention Program
MeSH terms
Cardiovascular Diseases, Diabetes Mellitus, Female, Humans, Hypertension, Hypoglycemic Agents, Life Style, Lipoproteins, LDL, Male, Metformin, Middle Aged, Myocardial Infarction, Risk Factors, Triglycerides, Hypertriglyceridemia, Glucose Intolerance, Stroke

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