Abstract:
Background - Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors — elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle — are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes.
Methods - We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups.
Results - The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.
Conclusions - Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
My Opinion:
From the article, the hypothesis formed was proven that lifestyle intervention and metformin succeeded in preventing or delaying diabetes in persons with high risk of the disease. This approach is not popular because type 2 diabetes or non-insulin-dependent diabetes mellitus is usually treated for after complications arise. Preventing metabolic diseases through diet and lifestyle has long been advised by health care professionals but prevention with the usage of a drug is not common. This research proved to be effective because it was systematic and intensive. Both lifestyle interventions and metformin groups showed effective results individually.
With the help of dietitians, nutritionists and fitness trainers, I believe a better prevention may be possible for persons with high risk of diabetes. Surveys and screenings can be conducted by family physicians, general physicians, nurses and midwives in the community they are entrusted to serve to identify those with high risk. From the article, persons of age 25 and above with BMI of more than 24 (22 for Asians) were selected.
This approach is very much possible in an Asian setting, more specifically in Yogyakarta city. This is because with the help of the midwives and the primary health centers (Puskesmas), mass screenings can be done thoroughly and prevention be carried out immediately. The people with high risk of diabetes need to be able to prevent diabetes that could lead to many other complications in the future.
The few problems that may arise are:
- Lack of compliance of participants
- Under-reporting of cases due to distance from the Puskesmas
- Availability of metformin drugs
- Accessibility of dietitians, nutritionists and fitness trainers to target groups
Reference:
http://www.nejm.org/doi/full/10.1056/NEJMoa012512#t=article
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