In a landmark follow-up to a pivotal clinical trial from the early 2000s, researchers have confirmed that intensive lifestyle modifications offer lasting benefits in preventing Type 2 diabetes. The original U.S. Diabetes Prevention Program (DPP) demonstrated that lifestyle changes were more effective than the medication metformin in reducing diabetes risk among at-risk individuals. Now, more than two decades later, the health advantages of these interventions remain evident.
The findings, published in The Lancet Diabetes & Endocrinology, reveal that the benefits of lifestyle interventions persisted over 20 years. Vallabh “Raj” Shah, a professor emeritus at The University of New Mexico, emphasized the durability of these results, noting,
“The data suggests that those people who didn’t get diabetes also didn’t get diabetes after 22 years.”
The Original Study and Its Findings
Launched in 1996, the DPP was designed to compare the effects of metformin, a then-newly FDA-approved drug for Type 2 diabetes, with a regimen of lifestyle changes, including exercise and a healthy diet. The study involved 3,234 prediabetic patients across 30 institutions in 22 states. Initial results showed that lifestyle interventions reduced diabetes development by 24%, while metformin achieved a 17% reduction.
These findings built on earlier results from the first three years of the study, where lifestyle changes led to a 58% reduction in diabetes onset compared to a placebo, and metformin resulted in a 31% reduction. The median diabetes-free period was extended by three-and-a-half years in the lifestyle group and two-and-a-half years in the metformin group.
Transition to Long-Term Outcomes
The DPP’s significant early results prompted an early end to the study, as lifestyle changes proved more effective than metformin. This led to the creation of the DPP Outcomes Study (DPPOS), which repurposed the wealth of collected health data to track participants’ health outcomes over decades.
Shah, who has extensive experience in kidney disease research, particularly within American Indian communities, has been instrumental in overseeing the American Indian cohort in DPPOS. Meanwhile, David Schade, MD, from the UNM School of Medicine, played a key role in recruiting New Mexico participants.
Expanding Research Horizons
More recently, DPPOS researchers have leveraged their comprehensive cohort data to explore diseases associated with aging, such as cancer and dementia. This shift highlights the study’s adaptability and the potential to uncover insights beyond diabetes prevention.
Implications and Future Directions
The enduring success of lifestyle interventions underscores the importance of preventive measures in chronic disease management. As healthcare systems worldwide grapple with rising diabetes rates, these findings advocate for prioritizing lifestyle modifications over pharmaceutical interventions when possible.
Experts suggest that the DPP and DPPOS offer a blueprint for long-term health studies, demonstrating the value of sustained lifestyle changes. The study’s outcomes could influence future public health policies, encouraging more comprehensive lifestyle-based prevention programs.
Looking ahead, researchers aim to continue exploring the extensive dataset provided by DPPOS, potentially uncovering new connections between lifestyle factors and other chronic conditions. As the study evolves, its findings will likely continue to inform and shape health strategies globally.
