Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
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DOI：
10.1056/nejmoa012512
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发表时间：
2002-02-07
影响因子：
158.5
通讯作者：
Nathan, DM
中科院分区：
文献类型：
--
作者：
Knowler, WC;Barrett-Connor, E;Nathan, DM
背景：2型糖尿病影响美国约8%的成年人。一些危险因素空腹和口服葡萄糖负荷后血糖浓度升高、超重和久坐的生活方式可能是可逆的。我们假设通过生活方式干预或二甲双胍治疗来改变这些因素可以预防或延缓糖尿病的发生。我们将3234名空腹血糖和负荷后血糖浓度升高的非糖尿病患者随机分为安慰剂组、二甲双胍组和对照组。（850毫克，每日两次），或生活方式改变计划，目标是至少减轻7%的体重，每周至少进行150分钟的体育活动。参与者的平均年龄为51岁，平均体重指数（体重（公斤）除以身高（米）的平方）为34.0; 68%为女性，45%为少数民族成员。安慰剂组、二甲双胍组和生活方式组的糖尿病发病率分别为11.0、7.8和4.8例/100人-年。与安慰剂相比，生活方式干预使发病率降低了58%（95%置信区间，48%至66%），二甲双胍降低了31%（95%置信区间，17%至43%）;生活方式干预明显比二甲双胍更有效。为了在三年内预防一例糖尿病，6.9人将不得不参加生活方式干预计划，13.9人将不得不接受二甲双胍。结论：生活方式的改变和二甲双胍治疗都降低了糖尿病高危人群的发病率。生活方式干预比二甲双胍更有效。
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.