TYPE 2 DIABETES

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Kace McKenna Winters

BBH/HPA 440 Assignment 3
Type 2 Diabetes
The article, Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or
Metformin, found in Volume 346 within The New England Journal of Medicine, notes that at the time of
this articles publication, diabetes was present in about 8 percent of the population; an important statistic
as the authors state that diabetes leads to a multitude of complications. It is for this reason that the
Diabetes Prevention Program Research Group were interested in identifying a possible reversal of factors
involved with type 2 diabetes via intervention within individuals located in the United States. The
researchers hypothesized that the development of type 2 diabetes could be prevented or delayed via a
lifestyle intervention program or a treatment with metformin by modifying the risk factors associated. The
hypothesis was tested using a prospective cohort study design.
Approximately 3,200 participants, who were presumed to be at high risk for the development of
type 2 diabetes, were chosen from 27 centers, and observed for an average of 2.8 years. These subjects
were separated into three interventions: one intervention where subjects were recommended to follow a
standard lifestyle, but received two placebo pills in addition; one intervention where subjects were
recommended to follow a standard lifestyle, but received two metformin pills in addition; and one
intervention that involved an intense lifestyle intervention. A fourth intervention was discontinued after
the medication was deemed toxic to the liver. The outcome measures included: the adherence to the
intervention; the incidence of diabetes; the treatment effects among subgroups; glycemic changes; and
adverse events.
As hypothesized, this research provided evidence to support the use of metformin and intense
lifestyle modification in preventing or delaying the development of type 2 diabetes in individuals at high
risk; although, lifestyle intervention was more effective than metformin. The research also identified that
these statistics were equally effective for men and women of all racial and ethnic backgrounds; however,
not across all age groups, as the lifestyle intervention was more effective in younger participants.

TYPE 2 DIABETES

Furthermore, this study identified one large limitation. The researchers recognized that in order to
be a participant in this study, the subjects needed to meet specific criteria that was in place as a predictor
for the onset of diabetes. This type of pooling for candidates creates a possible problem. It is for this
reason that the authors specifically state that it is unknown that the interventions would provide similar
results in those individuals without an elevation of either the fasting or the post load glucose
concentration.

References
Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. (2002). New
England Journal of Medicine N Engl J Med, 346(6), 393-403.