Pharmaceutical companies often make up trade names for new drugs that semi-subliminally evoke their purpose – some of my favorites are Boniva, for osteoporosis, or Ambien, the sleeping pill that sounds like it was named by Brian Eno. It’s kind of a silly practice, motivated mostly by marketing reasons, because all of these drugs already have names – Ambien’s true name, Zolpidem, is even kind of fun to say. But the fact that these trade names are so widespread suggests they are effective at attracting consumers, so here’s my modest proposal: let’s give simple changes in diet and exercise that improve health a fancy trade name, Lifestyltrin.
This train of thought stems from a study published last week by medical journal The Lancet, in which one of the largest diabetes studies showed (again) that changes in lifestyle are more effective than a leading medication in preventing the disease. Originally published in 2001, the Diabetes Prevention Program (DPP) followed more than 3000 people at risk for diabetes at hospitals across the United States as they underwent either a lifestyle intervention, treatment with anti-diabetic drug metformin, or a placebo treatment. After nearly 3 years of study, the authors reported that lifestyle changes (meaning diet and exercise to reduce weight) reduced diabetes incidence by almost 60%. Metformin also reduced the disease, but only by about 31% – results so strong that the authors stopped the study and began offering both treatments to everyone in their study.
But the study didn’t end, and the medical centers involved continued to monitor as many patients as were willing to stay in contact. All told, 2766 of the original 3234 participants continued to be monitored, allowing the publication last week of a followup study examining how many of these at-risk patients had developed diabetes 10 years after the original study began. What they found was somewhat status quo – after 10 years, the lifestyle group still showed twice the decrease of new diabetes cases than the drug group, 34% vs 18% lower compared to placebo. But that also means there was no difference in the number of new diabetes cases between lifestyle and drug groups in the 7 years between the original study’s end and the followup study’s end, which authors attributed to the mixture of treatments – the group receiving lifestyle interventions was now allowed access to metformin, and vice versa.
The University of Chicago Medical Center was one of the hospitals involved in planning and conducting this massive study, and I spoke over e-mail with David Ehrmann, professor of medicine and one of the Diabetes Prevention Program Research Group’s principal investigators.
Q: What is the importance of revisiting these patients ~7 years after the initial interventions?
Ehrmann: The idea is to look for durability of the effects of interventions, lifestyle vs. pharmacologic. The intitial study was short term. This study reports the long term results.
Q: What would you say the bottom line of the new study is for patients and doctors?
Ehrmann: I think that the persistent effects of interventions speak for the fact that lifestyle modification is the ideal manner by which to reduce the risk for development of diabetes among high risk persons. Alternate therapy would be metformin which is also effective, albeit to a lesser degree.
Q: Did the results of the original DPP study impact clinical treatment of people at risk for diabetes? Is metformin commonly used for this purpose?
Ehrmann: Yes, the original study had a major impact on the way in which impaired glucose tolerance (also referred to as “prediabetes”) is perceived and treated. Until the results of the initial study were published, it could only be assumed that intervention would delay or prevent conversion to diabetes. The results nailed that concept and raised awareness both in the medical and lay communities about the importance of early diagnosis and aggressive intervention.
Q: Do you expect the 10-year follow-up results to modify that clinical treatment in any way?
Ehrmann: They reinforce the initial findings and provide further evidence that intervention at an early stage of glucose intolerance is effective at reducing conversion to diabetes and further, that the intervention is durable.
Q: Is there any other conclusions that patients or physicians should take away from this study?
Ehrmann: Patients and physicians should be overwhelmingly convinced that those at risk for diabetes should be tested early and, if found to have impaired glucose tolerance (also referred to as prediabetes), should accept the need for intervention with lifestyle and/or metformin treatment.