Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program.
Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program.
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DOI：
10.1136/bmj.h454
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发表时间：
2015-02-19
期刊：
影响因子：
--
通讯作者：
Hayward RA
中科院分区：
文献类型：
--
作者：
Sussman JB;Kent DM;Nelson JP;Hayward RA
目的确定糖尿病预防项目的一些参与者是否更多或更少可能从二甲双胍或结构化生活方式改变项目中获益。设计糖尿病预防计划的事后分析，一项随机对照试验。设置门诊护理患者。参与者3060人，无糖尿病，但有证据表明糖代谢受损。干预干预组接受二甲双胍或生活方式改变计划，目标是减肥和体力活动。主要结果测量糖尿病的发展，根据糖尿病风险预测模型，根据发展糖尿病的风险分层。结果在3081名基线时糖代谢受损的参与者中，655名（21%）在中位2.8年的随访中进展为糖尿病。糖尿病风险模型具有良好的区分度（C统计量=0.73）和校准性。尽管生活方式干预在最高风险季度的绝对风险降低是最低风险季度的6倍，但最低风险季度的患者仍然获得了实质性获益（3年绝对风险降低4.9%，最高风险季度为28.3%;需要治疗的人数分别为20.4和3.5）。然而，二甲双胍的益处几乎完全见于糖尿病风险最高的四分之一的患者。在风险最低的季度没有看到任何好处。最高风险季度的参与者平均三年绝对风险降低21.4%（需要治疗的人数为4.6）。结论糖尿病高危患者从糖尿病预防治疗中获益的可能性存在很大差异。使用这些知识可以减少过度治疗，使糖尿病的预防更加有效，有效，以患者为中心，前提是决策是基于准确的风险预测工具。
Objective To determine whether some participants in the Diabetes Prevention Program were more or less likely to benefit from metformin or a structured lifestyle modification program. Design Post hoc analysis of the Diabetes Prevention Program, a randomized controlled trial. Setting Ambulatory care patients. Participants 3060 people without diabetes but with evidence of impaired glucose metabolism. Intervention Intervention groups received metformin or a lifestyle modification program with the goals of weight loss and physical activity. Main outcome measure Development of diabetes, stratified by the risk of developing diabetes according to a diabetes risk prediction model. Results Of the 3081 participants with impaired glucose metabolism at baseline, 655 (21%) progressed to diabetes over a median 2.8 years’ follow-up. The diabetes risk model had good discrimination (C statistic=0.73) and calibration. Although the lifestyle intervention provided a sixfold greater absolute risk reduction in the highest risk quarter than in the lowest risk quarter, patients in the lowest risk quarter still received substantial benefit (three year absolute risk reduction 4.9% v 28.3% in highest risk quarter; numbers needed to treat of 20.4 and 3.5, respectively). The benefit of metformin, however, was seen almost entirely in patients in the top quarter of risk of diabetes. No benefit was seen in the lowest risk quarter. Participants in the highest risk quarter averaged a 21.4% three year absolute risk reduction (number needed to treat 4.6). Conclusions Patients at high risk of diabetes have substantial variation in their likelihood of receiving benefit from diabetes prevention treatments. Using this knowledge could decrease overtreatment and make prevention of diabetes far more efficient, effective, and patient centered, provided that decision making is based on an accurate risk prediction tool.
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影响因子：
16.2
作者：
Diabetes Prevention Program Research Group
通讯作者：
Diabetes Prevention Program Research Group
影响因子：
158.5
作者：
Knowler, WC;Barrett-Connor, E;Nathan, DM
通讯作者：
Nathan, DM
DOI：
10.1161/circoutcomes.110.959239
发表时间：
2011-05
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Sussman JB;Vijan S;Choi H;Hayward RA
通讯作者：
Hayward RA
DOI：
10.1136/amiajnl-2012-001595
发表时间：
2014-05-01
影响因子：
6.4
作者：
Bellows, Jim;Patel, Samir;Young, Scott S.
通讯作者：
Young, Scott S.
影响因子：
4
作者：
Hayward, Rodney A;Kent, David M;Hofer, Timothy P
通讯作者：
Hofer, Timothy P