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In the early 2000s, the American Diabetes Prevention Program (DPP), a large randomized clinical trial, showed that it was superior to a drug therapy called metformin to prevent risk patients from developing type 2 diabetes.
In a newly completed follow-up study, a team of researchers, including Vallabh “Raj” Shah, professor emeritus at the University of New Mexico's Faculty of Internal Medicine, discovered that health benefits from lifestyle interventions continued more than 20 years later in the Faculty of Biochemistry and Biochemistry & Molecular Biology.
In a paper published in Lancet Diabetes and Endocrinology, they reported that the greatest results from both interventions were seen and durable in the first few years of the study, Shah said. “The data suggests that people who did not get diabetes also did not get diabetes after 22 years,” he said.
The DPP was launched in 1996 and compared the benefits of metformin – later newly approved by the FDA to treat type 2 diabetes. This study enrolled 3,234 prediabetic patients at 30 institutions in 22 states.
According to a new study, intensive lifestyle interventions reduced the onset of diabetes by 24%, while metformin reduced the onset of diabetes by 17%. After the first three years of study, DPP previously found that moderate weight loss and increased physical activity lifestyle interventions reduce the onset of type 2 diabetes by 58% compared to placebo medicine, and metformin reduces the onset of diabetes by 31%.
Compared to the original placebo group, the median diabetes-free time was extended by 3.5 years in the lifestyle group and 2.5 years in the metformin group.
“Within three years, they had to stop research because their lifestyle was better than metformin,” Shah said. “That means that the lifestyle where everyone is banking is more effective. That's the news.”
However, abundant health and biological data had already been collected for patients participating in the project, so DPP was reused in DPP Outcomes Research (DPPOS), allowing researchers to follow health outcomes of multiple domains over decades.
Sher has contributed to kidney disease research for over 30 years, and has conducted multiple studies in Zuni Pueblo, western New Mexico and other American Indian communities. He also oversees participation in the American Indian cohort registered with the DPPO. Meanwhile, MD David Schade, director of the Endocrinology Department of UNM School of Medicine, recruited participants from New Mexico for the study.
More recently, DPPOS researchers said they are using their large, well documented cohort to reuse their research to focus on aging-related diseases such as cancer and dementia.
reference: Heterogeneity of the long-term impact and efficacy of lifestyle and metformin interventions on 21-year incidence of type 2 diabetes in a randomized clinical trial of Knowler WC, Doherty L, Edelstein SL, and others. Lancet Diabetic Endocrinol. 2025; 13 (6): 469-481. doi:10.1016/s2213-8587(25)00022-1
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