Diabetes Prevention Program Maintains Benefit 10 Years Later

Marcia Frellick

December 01, 2016

More than 10 years after a lifestyle intervention program to prevent type 2 diabetes showed dramatic results, researchers have found the benefits are long-lasting.

The findings should encourage primary care physicians to get patients involved in these types of programs, lead author Bonny Rockette-Wagner, PhD, from the Department of Epidemiology at the University of Pittsburgh in Pennsylvania, told Medscape Medical News.

Lifestyle intervention was one group in the Diabetes Prevention Program (DPP) landmark trial, which concluded in 2000. Participants in the other groups received metformin or placebo.

The lifestyle intervention had two main goals: a 7% maintained weight loss and 150 minutes per week of moderate to vigorous physical activity (MVPA) at the intensity of a brisk walk.

The intervention featured several components including lifestyle coaches, trained through a national network, who kept in frequent contact with participants to help them maintain their goals; supervised physical activity sessions; and adherence strategies tailored to individual participants.

After the DPP trial demonstrated a 58% decrease in diabetes incidence among participants in the lifestyle intervention group compared with placebo, participants from all three study groups were offered a group version of the lifestyle intervention. Those who accepted were followed in the DPP Outcomes Study (DPPOS) for more than 10 years from the DPP trial baseline.

In the current study, Dr Rockette-Wagner and colleagues used accelerometer data to objectively measure whether the increased physical activity seen among DDPOS participants was sustained long-term. They published their findings online November 21 in the American Journal of Preventive Medicine.

Physical Activity Higher in DPPOS Group

The researchers found that MVPA levels were generally higher among DPPOS participants (n = 1574) than among a representative sample from the National Health and Nutrition Examination Survey (2003-2006) matched for sex, diabetes status, and age (n = 1839). For some DPPOS subgroups, the MVPA was up to twice as high.

In general, men had more MVPA and less light physical activity (LPA) than women (both P < .0001, respectively).

Also, both MVPA and LPA declined (P < .0001) and sedentary behavior increased with increasing age (P = .0008).

Because the accelerometer readings occurred over a single week, the researchers also examined questionnaire data.

A longitudinal questionnaire given to the DPP participants at baseline in 1996 and collected every year until 2010 backed up the positive results for the intervention. Data from the DPP/DPPOS questionnaire showed a consistent increase of 1.24 MET (metabolic equivalent) hours per week (P < .026) of leisure activity (which equals about an additional 25 minutes of brisk walking) in DPPOS participants from baseline to the reading of the accelerometer.

The fact that there was an increase was striking, Dr Rockette-Wagner told Medscape Medical News. "We expect people's activity to drop over a 10-year period in adulthood. Here, not only had it not declined in the DPP group, it's actually a little higher than it was at prior to the intervention more than 10 years ago."

Message for Primary Care Physicians

This study is unusual in its length of follow-up, she said. Studies of this nature also tend to focus on the weight loss, rather than on whether physical activity increases are sustained.

She noted a recent push to make physical activity prescriptions part of clinical practice and said these results should help answer the question of whether that matters.

Also, these benefits appear in the group version of the intervention after success was shown in the individual version, which is good news for cost-effectiveness.

There are many evidence-based translations of the DPP program, and the Centers for Disease Control and Prevention (CDC) lists CDC-approved programs and locations on its website.

Dr Rockette-Wagner acknowledged that finding insurance coverage for the programs can be a roadblock, but changes are happening.

For instance, as reported earlier by Medscape Medical News, the Centers for Medicare & Medicaid has recognized the benefits of the DPP, and starting in January 2018, Medicare will cover costs of the program for all eligible at-risk beneficiaries with prediabetes who are aged 65 years or older.

Primary care physicians can refer patients to programs through community-based organizations such as the YMCA.

"The doctors don't have to run these programs themselves. The idea is for them to refer patients to existing programs that have been endorsed by the CDC," Dr Rockette-Wagner said.

The authors have disclosed no relevant financial relationships.

Am J Prev Med. Published online November 21, 2016. Full text

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