Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program
Abstract
OBJECTIVE: To determine whether some participants in the Diabetes Prevention Program were more or less likely to benefit from metformin or a structured lifestyle modification program.
DESIGN: Post hoc analysis of the Diabetes Prevention Program, a randomized controlled trial.
SETTING: Ambulatory care patients.
PARTICIPANTS: 3060 people without diabetes but with evidence of impaired glucose metabolism.
INTERVENTION: Intervention groups received metformin or a lifestyle modification program with the goals of weight loss and physical activity.
MAIN OUTCOME MEASURE: Development of diabetes, stratified by the risk of developing diabetes according to a diabetes risk prediction model.
RESULTS: Of the 3081 participants with impaired glucose metabolism at baseline, 655 (21%) progressed to diabetes over a median 2.8 years' follow-up. The diabetes risk model had good discrimination (C statistic=0.73) and calibration. Although the lifestyle intervention provided a sixfold greater absolute risk reduction in the highest risk quarter than in the lowest risk quarter, patients in the lowest risk quarter still received substantial benefit (three year absolute risk reduction 4.9% v 28.3% in highest risk quarter; numbers needed to treat of 20.4 and 3.5, respectively). The benefit of metformin, however, was seen almost entirely in patients in the top quarter of risk of diabetes. No benefit was seen in the lowest risk quarter. Participants in the highest risk quarter averaged a 21.4% three year…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 3,081 participants or records.
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