Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention… (2024)

<jats:sec> OBJECTIVE To determine whether metformin or lifestyle modification can lower rates of all-cause and cause-specific mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study. </jats:sec> <jats:sec> RESEARCH DESIGN AND METHODS From 1996 to 1999, 3,234 adults at high risk for type 2 diabetes were randomized to an intensive lifestyle intervention, masked metformin, or placebo. Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone, but unmasked study metformin continued in those originally randomized. Causes of deaths through 31 December 2018 were adjudicated by blinded reviews. All-cause and cause-specific mortality hazard ratios (HRs) were estimated from Cox proportional hazards regression models and Fine-Gray models, respectively. </jats:sec> <jats:sec> RESULTS Over a median of 21 years (interquartile range 20–21), 453 participants died. Cancer was the leading cause of death (n = 170), followed by cardiovascular disease (n = 131). Compared with placebo, metformin did not influence mortality from all causes (HR 0.99 [95% CI 0.79, 1.25]), cancer (HR 1.04 [95% CI 0.72, 1.52]), or cardiovascular disease (HR 1.08 [95% CI 0.70, 1.66]). Similarly, lifestyle modification did not impact all-cause (HR 1.02 [95% CI 0.81, 1.28]), cancer (HR 1.07 [95% CI 0.74, 1.55]), or cardiovascular disease (HR 1.18 [95% CI 0.77, 1.81]) mortality. Analyses adjusted for diabetes status and duration, BMI, cumulative glycemic exposure, and cardiovascular risks yielded results similar to those for all-cause mortality. </jats:sec> <jats:sec> CONCLUSIONS Cancer was the leading cause of mortality among adults at high risk for type 2 diabetes. Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates. </jats:sec>

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FAQs

Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention…? ›

Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates.

Does metformin help with diabetes mortality? ›

Diabetics taking metformin had significantly lower all-cause mortality than non-diabetics (hazard ratio (HR) = 0.93, 95%CI 0.88–0.99), as did diabetics taking metformin compared to diabetics receiving non-metformin therapies (HR = 0.72, 95%CI 0.65–0.80), insulin (HR = 0.68, 95%CI 0.63–0.75) or sulphonylurea (HR = 0.80, ...

Is metformin better than lifestyle intervention for diabetes? ›

The study found that the lifestyle intervention group had a 50% reduction in the risk of diabetes, compared to a 31% reduction in the metformin group [21].

How effective is metformin in diabetes prevention? ›

The analysis demonstrated a significant reduction in the risk of diabetes among individuals receiving metformin medication interventions, as indicated by the risk ratio of 0.58. This finding suggests that individuals receiving metformin had a 42% lower risk of developing diabetes compared to those in the control group.

What is the diabetes prevention program lifestyle intervention? ›

The Diabetes Prevention Program (DPP) was a major multicenter clinical research study. The intervention involved a lifestyle change program focusing on calorie reduction and increasing physical activity to at least 150 minutes per week.

What is the effect of metformin and lifestyle interventions on mortality in the diabetes prevention program? ›

Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates.

Why are doctors taking patients off metformin? ›

Some people may need to stop taking metformin if they have kidney problems. Metformin doesn't directly harm the kidneys. But it can build up in your body if your kidneys aren't working well. Depending on your level of kidney function, your provider may decide that metformin isn't right for you anymore.

What is the lifestyle advice for metformin? ›

Be physically active for at least 30 minutes almost every day. Reach and maintain a healthy body weight. The extent of changes you need to make depends on your current lifestyle and blood glucose levels. Metformin is the first prescription medicine most people with type 2 diabetes start taking.

What is a safer alternative to metformin? ›

What are the best alternatives to metformin for Type 2 diabetes?
  • GLP-1 agonists like Ozempic. ...
  • SGLT2 inhibitors like Jardiance. ...
  • Mounjaro. ...
  • Insulin. ...
  • DPP-4 inhibitors like Januvia. ...
  • Thiazolidinediones like Actos. ...
  • Combination medications.
Jul 3, 2023

Do doctors still recommend metformin? ›

Why do doctors no longer recommend metformin? Doctors still often prescribe metformin to help treat T2DM. However, metformin may not be suitable for everyone with T2DM. For example, a doctor may prescribe alternative treatments, such as SGLT2 inhibitors, in people with kidney problems.

How long can a diabetic stay on metformin? ›

How long to take it for. Treatment for diabetes is usually for life. But if your kidneys are not working properly, your doctor will tell you to stop taking metformin and switch you to a different medicine. Do not stop taking metformin without talking to your doctor.

What are the long-term effects of taking metformin? ›

Long-term side effects

Taking metformin can cause vitamin B12 deficiency if you take it for a long time. This can make you feel very tired, breathless and faint, so your doctor may check the vitamin B12 level in your blood. If your vitamin B12 levels become too low, vitamin B12 supplements will help.

Will I become diabetic if I take metformin? ›

Metformin is a medicine used to treat type 2 diabetes and gestational diabetes. It's also used to help prevent type 2 diabetes if you're at high risk of developing it. Type 2 diabetes is a condition where the body does not make enough insulin, or the insulin that it makes does not work properly.

What was the primary goal of the diabetes prevention program? ›

The primary goal of the National DPP LCP is to delay the onset of Type 2 diabetes through weight loss by improving nutrition and physical activity levels.

What is lifestyle interventions in diabetes? ›

Intervention. Intensive lifestyle interventions provide ongoing counseling, coaching, or individualized guidance to patients with type 2 diabetes to help them change their diet, level of physical activity, or both. Patients must interact with program staff multiple times for a period of six months or longer.

What is the best diabetes prevention program? ›

CDC-led lifestyle change program

This research-based program focuses on healthy eating and physical activity. Research showed that people with prediabetes who joined a structured lifestyle change program could cut their risk of developing type 2 diabetes by 58% (71% for people over 60 years old).

Does metformin promote longevity? ›

In people, studies have shown that metformin improves age-related diseases, such as type 2 diabetes, cardiovascular disease and cognitive issues , which may lead to extended lifespan.

How successful is metformin for diabetes? ›

The best evidence for a potential role for metformin in the prevention of type 2 diabetes comes from The Diabetes Prevention Program (DPP) trial. Lifestyle intervention and metformin reduced diabetes incidence by 58% and 31%, respectively, when compared with placebo [7].

Can you manage diabetes just with metformin? ›

Children over 10 years old and adults over 18 with type 2 diabetes can take metformin. It can be used on its own to treat type 2 diabetes or with other diabetes medications including insulin.

Can you reverse diabetes while taking metformin? ›

We consider diabetes reversed when someone achieves an A1c below 6.5%, without requiring diabetes medications other than metformin. Metformin is excluded from reversal criteria because it is not diabetes-specific—many patients choose to stay on this medication for reasons other than blood sugar control.

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