For adults with prediabetes, lifestyle intervention can lower risk of developing multiple chronic conditions

A clinical trial supported by the National Institutes of Health (NIH) found that adults with prediabetes assigned to a lifestyle intervention had a significantly lower risk of developing multiple chronic health conditions (known as multimorbidity) over time than those assigned to a placebo. This study, which followed participants for more than two decades, also found that participants assigned to receive metformin did not experience a statistically significant reduction in multimorbidity risk. The findings, published in JAMA, highlight the lasting benefits of lifestyle programs that may lower the risk of developing chronic conditions.

“Multimorbidity is a common issue, and few interventions have been found to prevent or delay developing multiple chronic conditions,” said Marcel Salive, M.D., first author of the study, from NIH’s National Institute on Aging (NIA). “Our work showing that healthy lifestyle intervention can significantly lower the burden of multimorbidity is a step forward in addressing this growing problem.”

Previous research has shown that both metformin and lifestyle interventions have been successful in preventing or delaying diabetes and metabolic syndrome, but the researchers in this study wanted to determine whether these interventions could prevent or delay multimorbidity in addition to diabetes. The clinical trial was conducted at 27 sites in the U.S. and followed 1,173 participants who were at high risk of diabetes, were enrolled in Medicare, and consented to the linkage of their Centers for Medicare & Medicaid Services (CMS) claims.

In the first part of the study, the NIH Diabetes Prevention Program (DPP), from 1996 to 1999, participants were randomly assigned to an intensive lifestyle intervention, metformin (a drug commonly used in the management of type 2 diabetes), or a placebo. They were then enrolled in the DPP Outcomes Study (DPPOS) and followed through 2021.

In the first part of the study, lifestyle participants were offered 16 individual intervention sessions followed by monthly sessions for approximately two years. The behavior change program targeted reduced calories and fat, and at least 150 minutes of physical activity a week, to achieve greater than or equal to 7% weight loss from baseline. After the DPP trial was completed, all participants were offered the intensive lifestyle curriculum in groups during a six-month bridge period. During the outcomes study portion, all participants were offered quarterly group lifestyle sessions, and the original lifestyle participants received booster sessions twice a year.

By the end of follow-up, the researchers found that 85% of the study participants experienced two or more chronic conditions, with 82%, 85% and 87% experiencing multimorbidity among the lifestyle, metformin and placebo groups, respectively. Compared with the placebo group, participants in the lifestyle intervention had a 21% lower risk for two chronic conditions and a 25% lower risk for three chronic conditions. Participants assigned to metformin did not experience a statistically significant reduction in risk for multimorbidity.

The study examined 15 chronic conditions commonly tracked in Medicare data, including hypertension, heart disease, stroke, arthritis, chronic kidney disease, COPD, cancer, depression, dementia, osteoporosis and diabetes. These results persisted even when diabetes was removed from the multimorbidity definition.

“These findings are highly encouraging, reinforcing that lifestyle programs focused on diet and exercise may persistently lower the risk of developing multiple chronic conditions, beyond diabetes,” said Griffin P. Rodgers, M.D., director of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Furthermore, because lifestyle modifications can be safe and cost-effective, sustaining these healthy behaviors among people at risk of diabetes may help reduce not only the individual health burden but also broader health care spending.”