 |
 |
|
| ||||||||||||||||||||||||||||||||||||||||||||||
19 April 2005 | Volume 142 Issue 8 | Pages 611-619
Background: The metabolic syndrome is a high-risk state for diabetes and cardiovascular disease. Little is known about its prevalence and prevention in those with impaired glucose tolerance.
Objective: To determine the prevalence of the metabolic syndrome at baseline in the Diabetes Prevention Program and the effect of intensive lifestyle intervention and metformin therapy on the syndrome's incidence and resolution.
Design: Randomized, controlled clinical trial.
Setting: Research and community-based centers.
Participants: Participants had impaired glucose tolerance (World Health Organization criteria plus fasting plasma glucose level
Interventions: Metformin, 850 mg twice daily, or intensive lifestyle intervention designed to achieve and maintain a 7% weight loss and 150 minutes of exercise per week.
Measurements: The metabolic syndrome was defined as having 3 or more characteristics (waist circumference; blood pressure; and levels of high-density lipoprotein cholesterol, triglycerides, and fasting plasma glucose) that met criteria from the National Cholesterol Education Program Adult Treatment Panel III.
Results: Fifty-three percent of participants (n = 1711) had the metabolic syndrome at baseline; incidence did not vary substantially by age. However, low levels of high-density lipoprotein cholesterol predominated in younger participants (age 25 to 44 years), and high blood pressure predominated in older participants (age 60 to 82 years). In life-table analyses (log-rank test), incidence of the metabolic syndrome was reduced by 41% in the lifestyle group (P < 0.001) and by 17% in the metformin group (P = 0.03) compared with placebo. Three-year cumulative incidences were 51%, 45%, and 34% in the placebo, metformin, and lifestyle groups, respectively. There was no significant heterogeneity by ethnic group.
Limitations: The study involved a volunteer group with impaired glucose tolerance, which limits generalizability.
Conclusions: The metabolic syndrome affected approximately half of the participants in the Diabetes Prevention Program at baseline. Both lifestyle intervention and metformin therapy reduced the development of the syndrome in the remaining participants.
Editors' Notes
Context
Contribution
Implications
–The Editors
Author and Article Information
From the Diabetes Prevention Program Coordinating Center, The Biostatistics Center, George Washington University, Rockville, Maryland.
Grant Support: Funding was provided by the National Institutes of Health (5U01DK048489) through the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center on Minority Health and Health Disparities, the National Institute of Child Health and Human Development, the Office of Women's Health, and the National Institute on Aging. In addition, the Indian Health Service, the Centers for Disease Control and Prevention, the American Diabetes Association, and 2 pharmaceutical companies—Bristol-Myers Squibb and Parke-Davis—contributed support. The General Clinical Research Center Program, National Center for Research Resources, supported many of the clinical centers. Support to the clinical centers and the Coordinating Center was provided by the National Institute of Diabetes and Digestive and Kidney Diseases through a cooperative agreement, except for the Southwestern American Indian Centers, which were supported directly by the National Institute of Diabetes and Digestive and Kidney Diseases and the Indian Health Service.
Potential Financial Conflicts of Interest: Consultancies: T.J. Orchard (Metabolic Syndrome Alliance, Sanofi-Aventis); Grants received: R. Ratner (Bristol-Myers Squibb).
Requests for Single Reprints: Diabetes Prevention Program Coordinating Center, The Biostatistics Center, George Washington University, 6110 Executive Boulevard, Suite 750, Rockville, MD 20852.
Current Author Addresses: Dr. Orchard: Diabetes and Lipid Research Building, University of Pittsburgh, 3512 5th Avenue 203, Pittsburgh, PA 15213.
Ms. Temprosa and Dr. Fowler: George Washington University, Biostatistics Center, 6110 Executive Boulevard, Suite 750, Rockville, MD 20852.
Dr. Goldberg: Diabetes Research Institute, University of Miami School of Medicine, 1450 NW 10th Avenue R-77, Miami, FL 33136.
Dr. Haffner: Department of Medicine, Clinical Epidemiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 7873, San Antonio, TX 78229-3900.
Dr. Ratner: Medstar Research Institute, 6495 New Hampshire Avenue, Suite 201, Hyattsville, MD 20783.
Dr. Marcovina: Northwest Lipid Research Labs, 2121 North 35th Street, University of Washington, Seattle, WA 98103-9103.
Author Contributions: Conception and design: T.J. Orchard, M. Temprosa, R. Goldberg, S. Haffner, R. Ratner, S. Fowler.
Analysis and interpretation of the data: T.J. Orchard, M. Temprosa, R. Goldberg, R. Ratner, S. Fowler.
Drafting of the article: T.J. Orchard, M. Temprosa, R. Goldberg, S. Haffner, S. Fowler.
Critical revision of the article for important intellectual content: T.J. Orchard, M. Temprosa, R. Goldberg, S. Haffner, R. Ratner, S. Marcovina, S. Fowler.
Final approval of the article: T.J. Orchard, M. Temprosa, R. Goldberg, R. Ratner, S. Marcovina, S. Fowler.
Provision of study materials or patients: The DPP Research Group, T.J. Orchard, R. Goldberg, S. Haffner, R. Ratner, S. Marcovina.
Statistical expertise: M. Temprosa, S. Fowler.
Obtaining of funding: The DPP Research Group Principal Investigators.
Administrative, technical, or logistic support: T.J. Orchard, M. Temprosa, R. Goldberg, S. Marcovina, S. Fowler.
Collection and assembly of data: The DPP Research Group, T.J. Orchard, M. Temprosa, R. Goldberg. ARTICLE
The Effect of Metformin and Intensive Lifestyle Intervention on the Metabolic Syndrome: The Diabetes Prevention Program Randomized Trial
5.3 mmol/L [95 mg/dL]) and were followed for a mean of 3.2 years after random assignment to intensive lifestyle intervention, metformin therapy, or placebo.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  J. Salas-Salvado, J. Fernandez-Ballart, E. Ros, M.-A. Martinez-Gonzalez, M. Fito, R. Estruch, D. Corella, M. Fiol, E. Gomez-Gracia, F. Aros, et al. Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial Arch Intern Med, December 8, 2008; 168(22): 2449 - 2458. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Bo, G. Ciccone, S. Guidi, R. Gambino, M. Durazzo, L. Gentile, M. Cassader, P. Cavallo-Perin, and G. Pagano Diet or exercise: what is more effective in preventing or reducing metabolic alterations? Eur. J. Endocrinol., December 1, 2008; 159(6): 685 - 691. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.-A. Cornier, D. Dabelea, T. L. Hernandez, R. C. Lindstrom, A. J. Steig, N. R. Stob, R. E. Van Pelt, H. Wang, and R. H. Eckel The Metabolic Syndrome Endocr. Rev., December 1, 2008; 29(7): 777 - 822. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. T. Bloomgarden American College of Endocrinology Pre-Diabetes Consensus Conference: Part One Diabetes Care, October 1, 2008; 31(10): 2062 - 2069. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Rosenzweig, E. Ferrannini, S. M. Grundy, S. M. Haffner, R. J. Heine, E. S. Horton, and R. Kawamori Primary Prevention of Cardiovascular Disease and Type 2 Diabetes in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3671 - 3689. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K.-T. Li, B. C.-H. Kwan, C. C. Szeto, and G. T.-C. Ko Metabolic syndrome in peritoneal dialysis patients NDT Plus, August 1, 2008; 1(4): 206 - 214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. K. Kumanyika, E. Obarzanek, N. Stettler, R. Bell, A. E. Field, S. P. Fortmann, B. A. Franklin, M. W. Gillman, C. E. Lewis, W. C. Poston II, et al. Population-Based Prevention of Obesity: The Need for Comprehensive Promotion of Healthful Eating, Physical Activity, and Energy Balance: A Scientific Statement From American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (Formerly the Expert Panel on Population and Prevention Science) Circulation, July 22, 2008; 118(4): 428 - 464. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. R Desilets, S. Dhakal-Karki, and K. C Dunican Role of Metformin for Weight Management in Patients Without Type 2 Diabetes Ann. Pharmacother., June 1, 2008; 42(6): 817 - 826. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S Wierzbicki, S. D Purdon, T. C Hardman, R. Kulasegaram, and B. S Peters Review: Clinical aspects of the management of HIV lipodystrophy The British Journal of Diabetes & Vascular Disease, May 1, 2008; 8(3): 113 - 119. [Abstract] [PDF]
|
|
|
|
|
|
D. Giugliano, A. Ceriello, and K. Esposito Mediterranean Diet Inversely Associated With the Incidence of Metabolic Syndrome: the SUN Prospective Cohort: Response to Tortosa et al. Diabetes Care, May 1, 2008; 31(5): e36 - e36. [Full Text] [PDF]
|
|
|
|
|
|
P. Ilanne-Parikka, J. G. Eriksson, J. Lindstrom, M. Peltonen, S. Aunola, H. Hamalainen, S. Keinanen-Kiukaanniemi, M. Laakso, T. T. Valle, J. Lahtela, et al. Effect of Lifestyle Intervention on the Occurrence of Metabolic Syndrome and its Components in the Finnish Diabetes Prevention Study Diabetes Care, April 1, 2008; 31(4): 805 - 807. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. J. Mather, T. Funahashi, Y. Matsuzawa, S. Edelstein, G. A. Bray, S. E. Kahn, J. Crandall, S. Marcovina, B. Goldstein, R. Goldberg, et al. Adiponectin, Change in Adiponectin, and Progression to Diabetes in the Diabetes Prevention Program Diabetes, April 1, 2008; 57(4): 980 - 986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Hu, J. Lindstrom, P. Jousilahti, M. Peltonen, L. Sjoberg, R. Kaaja, J. Sundvall, and J. Tuomilehto The Increasing Prevalence of Metabolic Syndrome among Finnish Men and Women over a Decade J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 832 - 836. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-P. Despres, P. Poirier, J. Bergeron, A. Tremblay, I. Lemieux, and N. Almeras From individual risk factors and the metabolic syndrome to global cardiometabolic risk Eur. Heart J. Suppl., March 1, 2008; 10(suppl_B): B24 - B33. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Bianchi, R. Miccoli, G. Penno, and S. Del Prato Primary Prevention of Cardiovascular Disease in People With Dysglycemia Diabetes Care, February 1, 2008; 31(Supplement_2): S208 - S214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Giugliano, A. Ceriello, and K. Esposito Are there specific treatments for the metabolic syndrome? Am. J. Clinical Nutrition, January 1, 2008; 87(1): 8 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Giugliano, A. Ceriello, and K. Esposito Glucose metabolism and hyperglycemia Am. J. Clinical Nutrition, January 1, 2008; 87(1): 217S - 222S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. F. E. Praet and L. J. C. van Loon Optimizing the therapeutic benefits of exercise in Type 2 diabetes J Appl Physiol, October 1, 2007; 103(4): 1113 - 1120. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. F. Lien, A. J. Brown, J. D. Ard, C. Loria, T. P. Erlinger, A. C. Feldstein, P.-H. Lin, C. M. Champagne, A. C. King, H. L. McGuire, et al. Effects of PREMIER Lifestyle Modifications on Participants With and Without the Metabolic Syndrome Hypertension, October 1, 2007; 50(4): 609 - 616. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Emili, H. Abushomar, and K. Nair Treating metabolic syndrome: Lifestyle change or medication? Can Fam Physician, July 1, 2007; 53(7): 1203 - 1205. [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]
|
|
|
|
|
|
J. Waden, L. M. Thorn, C. Forsblom, T. Lakka, M. Saraheimo, M. Rosengard-Barlund, O. Heikkila, M. Wessman, J. A. Turunen, M. Parkkonen, et al. Leisure-Time Physical Activity Is Associated With the Metabolic Syndrome in Type 1 Diabetes: Effect of the PPAR{gamma} Pro12Ala polymorphism: the FinnDiane Study Diabetes Care, June 1, 2007; 30(6): 1618 - 1620. [Full Text] [PDF]
|
|
|
|
|
|
R. E Pratley and G. Matfin Review: Pre-diabetes: clinical relevance and therapeutic approach The British Journal of Diabetes & Vascular Disease, May 1, 2007; 7(3): 120 - 129. [Abstract] [PDF]
|
|
|
|
|
|
C. Y. Jeon, R. P. Lokken, F. B. Hu, and R. M. van Dam Physical Activity of Moderate Intensity and Risk of Type 2 Diabetes: A systematic review Diabetes Care, March 1, 2007; 30(3): 744 - 752. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Freemark Pharmacotherapy of Childhood Obesity: An evidence-based, conceptual approach Diabetes Care, February 1, 2007; 30(2): 395 - 402. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Abdul-Ghani, M. Matsuda, B. Balas, and R. A. DeFronzo Muscle and Liver Insulin Resistance Indexes Derived From the Oral Glucose Tolerance Test Diabetes Care, January 1, 2007; 30(1): 89 - 94. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Tice, A. Kanaya, T. Hue, S. Rubin, D. S. M. Buist, A. LaCroix, J. V. Lacey Jr, J. A. Cauley, S. Litwack, L. A. Brinton, et al. Risk Factors for Mortality in Middle-aged Women Arch Intern Med, December 11, 2006; 166(22): 2469 - 2477. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. W. Johnson and R. S. Weinstock The Metabolic Syndrome: Concepts and Controversy Mayo Clin. Proc., December 1, 2006; 81(12): 1615 - 1620. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Iribarren, A. S. Go, G. Husson, S. Sidney, J. M. Fair, T. Quertermous, M. A. Hlatky, and S. P. Fortmann Metabolic Syndrome and Early-Onset Coronary Artery Disease: Is the Whole Greater Than Its Parts? J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1800 - 1807. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. T. Page, J. K. Amory, B. D. Anawalt, M. S. Irwig, A. T. Brockenbrough, A. M. Matsumoto, and W. J. Bremner Testosterone Gel Combined with Depomedroxyprogesterone Acetate Is an Effective Male Hormonal Contraceptive Regimen and Is Not Enhanced by the Addition of a GnRH Antagonist J. Clin. Endocrinol. Metab., November 1, 2006; 91(11): 4374 - 4380. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. A. Neville, R. J. Cohn, K. S. Steinbeck, K. Johnston, and J. L. Walker Hyperinsulinemia, Impaired Glucose Tolerance, and Diabetes Mellitus in Survivors of Childhood Cancer: Prevalence and Risk Factors J. Clin. Endocrinol. Metab., November 1, 2006; 91(11): 4401 - 4407. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J O'Loughlin, E Dugas, K Maximova, and N Kishchuk Reporting of ethnicity in research on chronic disease: update Postgrad. Med. J., November 1, 2006; 82(973): 737 - 742. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Griel, E. H. Ruder, and P. M. Kris-Etherton The Changing Roles of Dietary Carbohydrates: From Simple to Complex Arterioscler. Thromb. Vasc. Biol., September 1, 2006; 26(9): 1958 - 1965. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J Moran, M. Noakes, P. M Clifton, G. A Wittert, G. Williams, and R. J Norman Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome Am. J. Clinical Nutrition, July 1, 2006; 84(1): 77 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. J. Davis, A. Emerenini, and J. Wylie-Rosett Obesity management: physician practice patterns and patient preference. The Diabetes Educator, July 1, 2006; 32(4): 557 - 561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. A Carpentier, L. Portois, and W. J Malaisse n-3 Fatty acids and the metabolic syndrome Am. J. Clinical Nutrition, June 1, 2006; 83(6): S1499 - 1504S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Esposito, M. Ciotola, D. Carleo, B. Schisano, F. Saccomanno, F. C. Sasso, D. Cozzolino, R. Assaloni, D. Merante, A. Ceriello, et al. Effect of Rosiglitazone on Endothelial Function and Inflammatory Markers in Patients With the Metabolic Syndrome Diabetes Care, May 1, 2006; 29(5): 1071 - 1076. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. K. de Aguiar, L. R. Bahia, N. Villela, C. Laflor, F. Sicuro, N. Wiernsperger, D. Bottino, and E. Bouskela Metformin Improves Endothelial Vascular Reactivity in First-Degree Relatives of Type 2 Diabetic Patients With Metabolic Syndrome and Normal Glucose Tolerance Diabetes Care, May 1, 2006; 29(5): 1083 - 1089. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Giugliano and K. Esposito Optimal Treatments for the Metabolic Syndrome Arterioscler. Thromb. Vasc. Biol., April 1, 2006; 26(4): e30 - e30. [Full Text] [PDF]
|
|
|
|
|
|
K. Esposito and D. Giugliano Beneficial Effects of a Dietary Approaches to Stop Hypertension Eating Plan on Features of the Metabolic Syndrome: Response to Azdbakht et al. Diabetes Care, April 1, 2006; 29(4): 954 - 955. [Full Text] [PDF]
|
|
|
|
|
|
D. Giugliano and K. Esposito The Metabolic Syndrome: Time for a Critical Appraisal: Joint Statement From the American Diabetes Association and the European Association for the Study of Diabetes: Response to Kahn et al. Diabetes Care, January 1, 2006; 29(1): 175 - 176. [Full Text] [PDF]
|
|
|
|
 |
|
 R. J Sigal A lifestyle intervention or metformin prevented or delayed the onset of metabolic syndrome in persons at risk Evid. Based Med., December 1, 2005; 10(6): 172 - 172. [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Dhahbi, P. L. Mote, G. M. Fahy, and S. R. Spindler Identification of potential caloric restriction mimetics by microarray profiling Physiol Genomics, November 17, 2005; 23(3): 343 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Anania, S. Parekh, and A. Shaukat The Diabetes Prevention Program and the Metabolic Syndrome Ann Intern Med, October 4, 2005; 143(7): 545 - 545. [Full Text] [PDF]
|
|
|
|
|
|
P. S. Sarinas and D. S. Dube The Diabetes Prevention Program and the Metabolic Syndrome Ann Intern Med, October 4, 2005; 143(7): 544 - 545. [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden 2nd International Symposium on Triglycerides and HDL: Metabolic syndrome Diabetes Care, October 1, 2005; 28(10): 2577 - 2584. [Full Text] [PDF]
|
|
|
|
 |
|
 Preventing Metabolic Syndrome by Preventing Diabetes DOC News, August 1, 2005; 2(8): 14 - 15. [Full Text]
|
|
|
|
|
|
Endocrinology & Metabolism News, June 2005 J. Clin. Endocrinol. Metab., June 1, 2005; 90(6): 16a - 16a. [Full Text] [PDF]
|
|
Read all Rapid Responses
Article
