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A decade later, lifestyle changes continue to lower type 2 diabetes risk

Released: Wednesday, October 28, 2009

BATON ROUGE - Confirming earlier findings of a decade ago, Pennington Biomedical Research Center scientists have joined others nationwide to verify a land-mark study that showed intensive lifestyle changes can ward off diabetes in those at high risk for the disease. Life changes designed to achieve and maintain modest weight loss reduced the rate of developing type 2 diabetes by 34 percent over ten years.

Lifestyle changes also yielded improvements in cardiovascular health, including lower blood pressure and triglyceride levels, allowing participants to take fewer drugs to control their heart disease risk, according to the study.

In comparison, treatment over the same length of time with the oral diabetes drug metformin reduced the rate of developing diabetes by 18 percent.

These are the results of the Diabetes Prevention Program Outcomes Study (DPPOS), a long-term follow up to the landmark Diabetes Prevention Program (DPP). Results of the DPPOS will appear online in The Lancet on Oct. 29, 2009.

“This just underscores the original findings that the serious condition of type 2 diabetes can be avoided through strict diet and physical activity,” said Dr. George Bray of the Pennington Biomedical Research Center. The Center was one of the original clinical sites for the DPP and the follow-up DPPOS.

The original study, the DPP, was a large, randomized trial involving 3,234 overweight or obese adults with elevated blood glucose levels. It was conducted at 27 centers nationwide and was the first major trial to show that lifestyle changes can effectively delay diabetes in a diverse population of overweight American adults at high risk of diabetes.

Researchers announced the initial findings of the DPP in 2001, a year earlier than scheduled because results were so clear: after three years, intensive lifestyle changes reduced the development of type 2 diabetes by 58 percent whereas metformin reduced it by 31 percent.

Striking as the findings were, researchers could not say how long the benefit would endure, since the results were based on just three years of data. So the investigators offered all participants, the placebo (control) group and metformin group in addition to the lifestyle change group, the opportunity to learn lifestyle changes and enroll in the DPPOS. 88 percent of DPP volunteers took part.

Intensive lifestyle changes consisted of lowering fat and calories in the diet and increasing regular physical activity to 150 minutes per week. Participants received training in diet, exercise (most chose walking), and behavior modification skills. In the first year of the DPP, this group lost 15 lbs. on average but regained all but about 5 pounds over 10 years. The metformin group has maintained a loss of about 5 pounds, and the placebo group lost less than 2 pounds over the decade.

About 5 to 6 percent of those in the lifestyle intervention group developed type 2 diabetes annually, an incidence rate that remained steady throughout the DPPOS. When the DPP ended in 2001, the metformin and placebo groups were developing diabetes at the rate of 8 and 11 percent a year, respectively. In 10 years, however, the yearly diabetes incidence rates for the drug and placebo groups had also fallen to about 5 to 6 percent, and the lifestyle intervention group’s rate remained at this lower level.

The researchers are looking at a number of explanations for the convergence of diabetes incidence rates for the three groups. One may be that lifestyle changes adopted by the drug and placebo groups after the DPP ended may have lowered their rate of type 2 diabetes over time.

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The Pennington Biomedical Research Center is at the forefront of medical discovery as it relates to understanding the causes of obesity, diabetes, cardiovascular disease, cancer and dementia. Itis a campus of the Louisiana State University System and conducts basic, clinical and population research. The research enterprise at the Center includes approximately 80 faculty and more than 25 post-doctoral fellows who comprise a network of 50 laboratories supported by lab technicians, nurses, dieticians, and support personnel, and 19 highly specialized core service facilities.  The Center's more than 500 employees perform research activities in state-of-the-art facilities on the 234-acre campus located in Baton Rouge, Louisiana.