Pharmacotherapy, lifestyle intervention that is effective in preventing type 2 diabetes but not in preventing cardiovascular disease

Increased physical activity, a healthy diet, a lifestyle intervention program aimed at weight loss of 7% or more, or taking metformin have long-term effects in delaying or preventing type 2 diabetes in adults with prediabetes. .. However, both approaches risk cardiovascular disease in 21-year study participants, according to the findings of the Multicenter Diabetes Prevention Program Outcome Study (DPPOS) published today in the peer-reviewed journal of the American Heart Association. Did not mitigate. Circulation.

Type 2 diabetes (T2D) is the most common form of diabetes, affecting more than 34 million people in the United States and nearly 11% of the U.S. population, according to the Centers for Disease Control and Prevention’s 2020 National Diabetes Statistics Report. Occupies. Cardiovascular disease (CVD) is the leading cause of death and disorder in patients with type 2 diabetes. Type 2 diabetes occurs when the body cannot use the insulin it makes efficiently and the pancreas cannot produce enough insulin. Adults with T2D are twice as likely to die of CVD, including heart attacks, strokes, and heart failure, compared to adults without T2D. People with type 2 diabetes often have other risk factors for cardiovascular disease. Overweight Or have obesity, high blood pressure or high cholesterol.

DPPOS evaluated a 21-year follow-up (up to 2019) of 3,234 adults who participated in the first three-year diabetes prevention program (DPP) trial. This analysis of DPPOS determines whether the drug metformin or lifestyle intervention may reduce the risk of cardiovascular disease or the incidence of major heart events such as heart attack, stroke or death due to cardiovascular disease. I focused on that.

The risk of cardiovascular disease in pre-diabetic patients increases, and the risk of CVD increases over time after the onset and progression of type 2 diabetes. We focused on assessing the impact of lifestyle or metformin interventions to prevent type 2 diabetes in pre-diabetic patients in order to alleviate cardiovascular disease. “

Ronald B. Goldberg, MD, Chair of the DPPOS Writing Group, Professor of Medicine, Biochemistry, and Molecular Biology in the Departments of Diabetes, Endocrinology, and Metabolism, and Senior Professor and Co-Director of the Clinical Institute of Diabetes Institute, Miami, Florida. Miller Medicine School of Miami University in

The DPP was a groundbreaking 27-center randomized trial across the United States from 1996 to 2001 to evaluate ways to prevent or delay the onset of type 2 diabetes in prediabetic patients. Research participants were screened based on these criteria and accepted by DPP. First, a 2-hour glucose measurement of 140-199 mg / dL in an oral glucose tolerance test. Fasting blood glucose level of 95-125 mg / dL; Body mass index is 24 kg / m²that’s all.

A racially diverse group of 3,234 adults was studied at the original DPP for almost three years. The average age of the participants was 51, with nearly 70% of the participants being women. People in an intensive lifestyle intervention group (nutrition improvement and physical activity aimed at achieving 7% weight loss) reduced the incidence of type 2 diabetes by 58% and metformin 2 times daily. Participants who took the dose reduced the incidence by 31% when compared to people in the placebo group who received standard care, including information on effective treatment and management of T2D at diagnosis.

DPPOS was launched in 2002 and was open to all participants in the first DPP trial. DPPOS enrolled nearly 90% of the original study participants for up to 25 years of follow-up to assess the long-term effects of interventions on the development of T2D and its complications. The success of the lifestyle intervention provided all of the studies to enroll in the lifestyle intervention in a group format during the one-year bridge period. The group taking metformin in the first DPP trial was aware that they could continue to take the drug during DPPOS and were taking metformin instead of placebo. (The group of metformin and placebo was blinded by the original DPP, so participants were not sure whether they were taking metformin or placebo during that period.)

“From the beginning of the diabetes prevention program, we were mainly interested in whether prevention of diabetes would reduce the incidence of complications (cardiovascular disease, renal disease, retinopathy, neuropathy) caused by type 2 diabetes. “. Goldberg. “Blood glucose control is important and encourages intervention to prevent long-term complications of type 2 diabetes.”

DPPOS is to compare the results of each intervention group with the placebo group to determine the impact of lifestyle and metformin interventions on the risk of non-fatal heart attack, stroke, or death participants due to cardiovascular development. , Evaluated the results of cardiovascular disease. Researchers reported results based on a median follow-up of 21 years, including an average follow-up of 3 years for the first DPP trial. The authors performed a futile analysis of cardiovascular outcomes and, as a result, completed the study before completing the planned 25-year follow-up.

Throughout the study, participants were screened annually by electrocardiography. Measurement of risk factors for cardiovascular disease, such as smoking, cholesterol and blood pressure. And body mass index measurement. The proportion of all participants taking blood pressure and cholesterol-lowering medications increased during the study period and was slightly lower among the participants in the lifestyle group compared to the other two groups.

After an average of 21 years of follow-up, researchers found no significant difference in the incidence of heart attack, stroke, or cardiovascular death among the three intervention groups. Specifically, the analysis revealed the following:

• Development of T2D has had continuous reductions or delays for up to 15 years.
• The number of non-fatal heart attacks in each group was similar. There were 35 heart attacks in the lifestyle intervention group. 46 people in the Metformin group. 43 people in the placebo group.
• Similarities were found in the number of non-fatal strokes. The incidence of stroke in the lifestyle intervention group was 39. 16 people in the metformin-only group. 28 people in the placebo group.
• The number of deaths due to the development of the cardiovascular system was low. Thirty-seven lifestyle intervention participants died. 39 people in the metformin group. Twenty-seven participants took placebo during the initial DPP trial.

“The fact that neither lifestyle intervention programs nor metformin has led to a reduction in cardiovascular disease in pre-diabetic patients, despite the fact that these interventions are very effective in preventing or delaying the onset of cardiovascular disease. It may mean that it has limited or no effect on the prevention of cardiovascular disease. Type 2 diabetes. ” “It is important to note that most study participants have also been treated with cholesterol and blood pressure medications that are known to reduce the risk of CVD. Therefore, the development of overall cardiovascular disease. The low rates may be due to these drugs. It is difficult to identify the beneficial effects of lifestyle and metformin interventions. To prevent cardiovascular disease in people with pre-diabetes and type 2 diabetes. Developing a more targeted approach requires future research to identify higher-risk subgroups. “

The study had some limitations. Researchers have selected a subgroup of people who meet the criteria for pre-diabetes, but these results cannot be generalized to all people with pre-diabetes. In addition, the intensity of lifestyle intervention decreased after the initial DPP phase, and medication adherence by participants in the metformin group gradually decreased over the 21-year study period.There was also the use of metformin outside the study Diagnosed with type 2 diabetes, This may dilute the differences between research groups. Higher levels of blood pressure and cholesterol medications prescribed by participants’ primary care teams, and reduced use of blood pressure medications in lifestyle groups may have affected the results. Cardiovascular events may have been underestimated because some participants did not complete the 21-year follow-up.

“These long-term findings confirm that the link between type 2 diabetes and cardiovascular disease is complex and needs further research to better understand it,” said the US Heart. Chief Medical Officer for Prevention of the Association, clinical leader of Eduardo Sanchez, MD, MPH, FAHA, FAAFP, and Know Diabetes by Heart. It is a joint initiative between the American Heart Association and the American Diabetes Association, working on the link between diabetes and cardiovascular disease. “But these important results also show that lifestyle interventions are very effective in delaying or preventing type 2 diabetes and, in and of themselves, reduce the risk of cardiovascular disease. It is estimated that one in three adults in the United States has pre-diabetes, prevention or delay of type 2 diabetes helps to extend and improve the lives of millions of people in public health. This is a requirement above. “