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Findings Point Toward Customized Diabetes Prevention

Mary Caffrey
The findings generated data on 19 specific clinical variables that could help physicians and patients made personalized decisions about diabetes prevention.
The study also yielded data on whether each variable was associated with progressing to diabetes or returning to normal blood glucose regulation, and the answer could change depending on the study arm. Researchers found that 11 measures predicted a progression to diabetes, while 6 predicted a regression to normal glucose regulation, but only 3 were seen across all groups. For example, a male college graduate who had lower systolic blood pressure at baseline might be expected to return to NGR in the metformin group, but not in the placebo or lifestyle intervention group.

Herman explained the value of these findings. “Randomized, controlled trials like the Diabetes Prevention Program assess whether treatments work and report average benefit. We show that the benefit to an individual varies greatly, even within a seemingly homogenous study population.”

The hope, he said, is that the algorithms from the study will let patients assess their own likelihood to benefit from the prevention choices available, “and act accordingly.”

Adherence Is Still Hard
Only 62% of the lifestyle participants, 68% of the metformin participants, and 72% of the placebo participants could stick with their programs. However, the researchers found that those who could adhere to the lifestyle intervention were less likely to progress to T2D than those who consistently took metformin. (Medication adherence was defined as taking the drug or placebo at least 80% of the time.)

Herman said each person’s assessment of their ability to adhere to an intervention is critical. “The knowledge of the potential benefits of participating in a lifestyle or metformin intervention is important, but individuals must also weigh the feasibility of adhering to the intervention,” he said. “I think the takeaway point is that providers should support whichever course of action and individual thinks is best—recognizing that the choice may change over time.”

Herman WH, Pan Q, Edelstein SL, et al. Impact of lifestyle and metformin interventions on the risk and progression to diabetes and regression to normal glucose regulation in overweight or obese people with impaired glucose regulation [published online October 11, 2017]. Diabetes Care.

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