Long-term follow-up of the Diabetes Prevention Program shows sustained reductions in diabetes incidence among individuals at risk for developing type 2 diabetes.

Background

Weight gain and limited physical activity have contributed to an increase in type 2 diabetes over the past several decades. In response, The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) launched the Diabetes Prevention Program (DPP), which demonstrated that intensive lifestyle changes or medication (metformin) could reduce the risk of developing diabetes amongst individuals with prediabetes. This follow-up study, known as the Diabetes Prevention Program Outcomes Study (DPPOS), looks at 20 years of data to see how diet and exercise changes, as well as medication, helped prevent diabetes compared to a control group.

Findings

Individuals included in the DPPOS were either assigned to DPP, metformin, or control groups. At the end of the first phase of the study in 2001, DPP reduced diabetes risk by 58% and metformin reduced risk by 31%. As of early 2020, individuals in the DPP group had a 24% reduction in diabetes, greater than the 17% reduction in the metformin group versus the control group. DPP improved outcomes for those at greater risk of diabetes, including those with higher blood glucose and A1c levels. Additional phases of the DPPOS have measured impacts of DPP on diabetes-related complications, which have shown limited results.  

Program/Policy Takeaways

Long-term evidence from DPP shows that lifestyle interventions can significantly reduce diabetes risk among people with prediabetes, with benefits sustained for more than 20 years. Policymakers and providers can consider implementing and expanding access to lifestyle-based diabetes prevention programs for high-risk populations to help delay or prevent diabetes onset, leading to improved long-term health outcomes and reduced disease burden.