Your high-risk patients may sometimes tire of hearing that they must watch their weight and achieve a sufficient level of physical activity to ward off type 2 diabetes, but they might be encouraged by the latest evidence supporting the benefits of such a regimen. Results from the Diabetes Prevention Program Outcomes Study (DPPOS)—the long-term follow-up study to the Diabetes Prevention Program (DPP)—indicate that intensive lifestyle changes aimed at modest weight loss and increased physical activity continue to reduce the rate of type 2 diabetes after 10 years.

Metformin also was shown to keep diabetes at bay effectively, “but the cumulative incidence of diabetes remained lowest in the lifestyle group” compared with those who had been treated with metformin or placebo rather than with lifestyle interventions, according to the DPP Research Group, which authored the study (Lancet. 2009;374:1677-1686).

In the nearly three-year duration of the original DPP clinical trial, intensive lifestyle intervention reduced diabetes incidence in high-risk adults by 58% more than placebo; metformin reduced disease incidence by 31% more than placebo. In the DPPOS follow-up, the DPP Research Group investigated the long-term persistence of these effects in 910 members from the lifestyle group, 924 from the metformin group, and 932 from the placebo group.

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“In 10 years, participants in the lifestyle-changes group delayed type 2 diabetes by about four years compared with placebo, and those in the metformin group delayed it by two years,” reports study chair David M. Nathan, MD, of Massachusetts General Hospital in Boston, in a statement issued by the National Institute of Diabetes and Digestive and Kidney Diseases. “The benefits of intensive lifestyle changes were especially pronounced in the elderly; people age 60 and older lowered their rate of developing type 2 diabetes in the next 10 years by about half.”