Intensive lifestyle intervention (they) is the most effective in delaying the progression of diabetes among people with a higher basic HBA1cWhile the effects of the treatment of metformin tends to be the most important in younger than older patients, according to the results of the study published in THE Lancet.
In studies involving adults at high risk of type 2 diabetes (T2D), evidence argues that behavioral and pharmacological interventions delay or prevent the start of diabetes for several years. However, data on their long -term effectiveness remains limited.
To examine potential heterogeneity and long -term effects of treatment during a 21 -year -old follow -up period between July 1996 and February 2020, researchers led the prevention program for randomized American diabetes (DPP; Clinicaltrials.gov ID: NCT00004992) and the study of DPP results (DPPOS; Clinicaltrials.Gov ID: NCT00038727) Tests.
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The relative advantages of they and drug interventions could change with future research on new drugs, including GLP-1RA, which reduce hyperglycemia and body weight, and with long-term maintenance of behavioral weight loss.
The researchers randomly assigned participants to 1 of the 3 groups: placebo, metformineOr they. After unmasking, the researchers interrupted the placebo, the continuation of the metformin (850 mg twice a day as tolerated), offered lessons in the lifestyle twice a year to the group they and provided all the participants of the lifestyle sessions based on the group 4 times a year. For all participants in the population studied, the researchers used a homogeneous double fish model to calculate the rate difference (RD) and the respective confidence intervals.
The main result was the incidence of diabetes, defined as plasma glucose with semi-annual fasting of 126 mg / dl or more (≥ 7.0 mmol / l) or 2-h plasma glucose of 200 mg / dl or more (≥ 11.1 mmol / l) in a tolerance test with oral glucose of 75 g annual.
The study included 3195 participants, comprising 1024 (32.1%) men and 2171 (67.9%) women with an average age of (SD) of 50.6 (10.7) years.
During the follow -up period, ILA and metformin vs placebo considerably reduced the impact of diabetes, with notable gains in diabetes -free survival.
Compared to the placebo, the group they had:
- 24% reduction in the risk of diabetes (risk ratio (HR), 0.76; 95% CI, 0.68-0.85);
- 1.59 fewer cases for 100 years (RD, -1.59; 95%CI, -2.25 to -0.93); And,
- Survival increases without median and average diabetes of diabetes 3.5 years and 2.0 years, respectively.
On the other hand, the metformin group vs placebo had:
- 17% reduction in the risk of diabetes (HR, 0.83; 95% CI, 0.74-0.93);
- 1.17 fewer cases for 100 years (RD, -1.17; 95%CI, -1.85 to -0.49); And,
- Diabetes and median diabetes and diabetes of diabetes of 2.5 years and 1.2 years, respectively.
On the HR scale, the effects they were generally homogeneous but more important in those who have a lower basic hba1cWhile the effects of metformin were homogeneous. On the RD scale, the effects they were larger among the most high risk of the bottom of the base line of glucose and Hba1c Subgroups, while the effects of metformin were greater in younger patients vs older.
Limitations of the study include limited generalized generalization due to a rigorous evaluation of diabetes and to specific eligibility criteria, reduced interpretability of the evolution of adherence to intervention over time, analyzes of imprecise sub-groups due to small sizes and the inability to make direct comparisons with more recent treatments such as agonists Glucagon type peptide-1 (GLP-1).
The authors concluded: “The relative advantages of they and drug interventions could change with future research on new drugs, including GLP-1-1, which reduce hyperglycemia and body weight, and with improvements in long -term maintenance of behavioral weight loss. »»