Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study

Medientyp: E-Artikel
Titel: Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study
Beteiligte: Lee, Christine G.; Heckman-Stoddard, Brandy; Dabelea, Dana; Gadde, Kishore M.; Ehrmann, David; Ford, Leslie; Prorok, Philip; Boyko, Edward J.; Pi-Sunyer, Xavier; Wallia, Amisha; Knowler, William C.; Crandall, Jill P.; Temprosa, Marinella; Bray, George A.; Gadde, Kishore M.; Culbert, Iris W.; Arceneaux, Jennifer; Chatellier, Annie; Dragg, Amber; Champagne, Catherine M.; Duncan, Crystal; Eberhardt, Barbara; Greenway, Frank; Guillory, Fonda G.; [...]
Erschienen: American Diabetes Association, 2021
Erschienen in: Diabetes Care
Sprache: Englisch
DOI: 10.2337/dc21-1046
ISSN: 1935-5548; 0149-5992
Schlagwörter: Advanced and Specialized Nursing ; Endocrinology, Diabetes and Metabolism ; Internal Medicine
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Beschreibung: <jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>To determine whether metformin or lifestyle modification can lower rates of all-cause and cause-specific mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study.</jats:p> </jats:sec> <jats:sec> <jats:title>RESEARCH DESIGN AND METHODS</jats:title> <jats:p>From 1996 to 1999, 3,234 adults at high risk for type 2 diabetes were randomized to an intensive lifestyle intervention, masked metformin, or placebo. Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone, but unmasked study metformin continued in those originally randomized. Causes of deaths through 31 December 2018 were adjudicated by blinded reviews. All-cause and cause-specific mortality hazard ratios (HRs) were estimated from Cox proportional hazards regression models and Fine-Gray models, respectively.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Over a median of 21 years (interquartile range 20–21), 453 participants died. Cancer was the leading cause of death (n = 170), followed by cardiovascular disease (n = 131). Compared with placebo, metformin did not influence mortality from all causes (HR 0.99 [95% CI 0.79, 1.25]), cancer (HR 1.04 [95% CI 0.72, 1.52]), or cardiovascular disease (HR 1.08 [95% CI 0.70, 1.66]). Similarly, lifestyle modification did not impact all-cause (HR 1.02 [95% CI 0.81, 1.28]), cancer (HR 1.07 [95% CI 0.74, 1.55]), or cardiovascular disease (HR 1.18 [95% CI 0.77, 1.81]) mortality. Analyses adjusted for diabetes status and duration, BMI, cumulative glycemic exposure, and cardiovascular risks yielded results similar to those for all-cause mortality.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Cancer was the leading cause of mortality among adults at high risk for type 2 diabetes. Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates.</jats:p> </jats:sec>
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