We Know How to Prevent Diabetes, So Why Don’t We?
Back in 1996, Microsoft was promoting Windows 95 "Chicago." The Summer Olympics opened in Atlanta. General Motors released the EV1, the first production electric car. Our knowledge of Diabetes was expanding.
Scientists with The Diabetes Prevention
Program Research Group set out to answer two basic questions:
Does
lifestyle intervention or treatment with metformin prevent or delay
the onset of
Type II Diabetes?
Do these
interventions differ in effectiveness, and does it differ with age,
sex, or ethnicity?
A total of 3,234 patients at 26 centers at risk for but
without diabetes were randomized to three groups: a Metformin Goup, an Intensive
Lifestyle Intervention Group, and a Control Group.
The Metformin Goup received standard
lifestyle recommendations (NCEP Step 1 diet) and meformin 850mg twice
daily.
The Control Group received the same standard lifestyle
recommendations and placebo.
The Intensive Lifestyle Intervention
Group received a 16 lesson curriculum covering diet, activity, and
behavioral modification – NOT traditionally part of the standard lifestyle
recommendations. It included goals of 7% weight loss and 150 minutes a week of physical activity.
The ground breaking results published in The New
England Jounal of Medicine February 7, 2002 demonstrated that both
Intensive Lifestyle Intervention and Metformin reduced the
incidence of Diabetes in persons at risk. Interestingly, The
Intensive Lifestyle Intervention was found more effective than Metformin
and Standard lifestyle recommendations.
The breakdown was as follows:
11 new cases of
Diabetes per 100 person years in the Control/Placebo Group.
7.8 new
cases of
Diabetes per 100 person years in the Metformin Group.
4.8 new cases of Diabetes per 100 person years in the Intensive
Lifestyle Group.
Put another way, the number of people needed to
treat to prevent one new case of Diabetes was 6.9 for the Intensive
Lifestyle Group and 13.9 for the Metformin Group. For every 7 people who engaged in the Intensive Lifestyle program one person would NOT develop Diabetes. For every 14 people who took metformin one person would NOT develop Diabetes.
Intensive Lifestyle Intervention was
more effective in older people, people with lower baseline glucose, and those with lower
BMI. Metformin was more effective in younger people, people with higher baseline
glucose, and those with higher BMI.
The Centers for Medicare & Medicaid Services offered a glimmer of hope in March 2016. The Office of The Actuary issued a report stating expansion of the YMCA's Diabetes Prevention Program as a covered benefit WOULD NOT result in an increase in Medicare spending but would actually save money. Today, Medicare recipients can enroll with a CDC certified program.
Is it enough? Sadly – NO. In spite
of reams of evidence based medicine published over the last 20 years only a minority of at risk people are aware of or encouraged to
partake in such proven interventions.
It is time for change.
Reduction in the incidence of type 2
diabetes with lifestyle intervention or metformin.
Knowler WC1, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM,
Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Recertification of the Medicare Diabetes Prevention Program Expansion
https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Diabetes-Prevention-Recertification-2017-11-01.pdf
Medicare Diabetes Prevention Program (MDPP) Expanded Model
https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/
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