Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study
| Autor: | Christine G, Lee, Brandy, Heckman-Stoddard, Dana, Dabelea, Kishore M, Gadde, David, Ehrmann, Leslie, Ford, Philip, Prorok, Edward J, Boyko, Xavier, Pi-Sunyer, Amisha, Wallia, William C, Knowler, Jill P, Crandall, Marinella, Temprosa, Marie-France, Hivert |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Advanced and Specialized Nursing medicine.medical_specialty business.industry Endocrinology Diabetes and Metabolism Hazard ratio Type 2 diabetes Disease Placebo medicine.disease Metformin Diabetes Mellitus Type 2 Cardiovascular Diseases Interquartile range Diabetes mellitus Internal medicine Internal Medicine medicine Humans Hypoglycemic Agents business Life Style Cause of death medicine.drug |
| Zdroj: | Diabetes Care. 44:2775-2782 |
| ISSN: | 1935-5548 0149-5992 |
| Popis: | OBJECTIVE To determine whether metformin or lifestyle modification can lower rates of all-cause and cause-specific mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study. RESEARCH DESIGN AND METHODS From 1996 to 1999, 3,234 adults at high risk for type 2 diabetes were randomized to an intensive lifestyle intervention, masked metformin, or placebo. Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone, but unmasked study metformin continued in those originally randomized. Causes of deaths through 31 December 2018 were adjudicated by blinded reviews. All-cause and cause-specific mortality hazard ratios (HRs) were estimated from Cox proportional hazards regression models and Fine-Gray models, respectively. RESULTS Over a median of 21 years (interquartile range 20–21), 453 participants died. Cancer was the leading cause of death (n = 170), followed by cardiovascular disease (n = 131). Compared with placebo, metformin did not influence mortality from all causes (HR 0.99 [95% CI 0.79, 1.25]), cancer (HR 1.04 [95% CI 0.72, 1.52]), or cardiovascular disease (HR 1.08 [95% CI 0.70, 1.66]). Similarly, lifestyle modification did not impact all-cause (HR 1.02 [95% CI 0.81, 1.28]), cancer (HR 1.07 [95% CI 0.74, 1.55]), or cardiovascular disease (HR 1.18 [95% CI 0.77, 1.81]) mortality. Analyses adjusted for diabetes status and duration, BMI, cumulative glycemic exposure, and cardiovascular risks yielded results similar to those for all-cause mortality. CONCLUSIONS Cancer was the leading cause of mortality among adults at high risk for type 2 diabetes. Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates. |
| Databáze: | OpenAIRE |
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