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Long-term Effects of Metformin on Diabetes Prevention: Identification of Subgroups That Benefited Most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study

Diabetes care, 2019-04, Vol.42 (4), p.601-608 [Peer Reviewed Journal]

2019 by the American Diabetes Association. ;Copyright American Diabetes Association Apr 1, 2019 ;2019 by the American Diabetes Association. 2019 ;ISSN: 0149-5992 ;EISSN: 1935-5548 ;DOI: 10.2337/dc18-1970 ;PMID: 30877090

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Title:
Long-term Effects of Metformin on Diabetes Prevention: Identification of Subgroups That Benefited Most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study
Author: Crandall, Jill P. ; Goldberg, Ronald B. ; Temprosa, Marinella ; Ehrmann, David ; Matulik, Margaret J. ; Czech, Kirsten ; DeSandre, Catherine ; Furlong, Kevin ; Pepe, Constance ; Calles, Jeanette ; Ojito, Juliet ; Lara, Olga ; Veciana, Beth ; Haffner, Steven M. ; Walker, Tatiana ; Testaverde, Lisa ; Steinke, Sheila C. ; Horton, Edward S. ; Swift, Kati ; Caballero, Enrique ; Guidi, Ashley ; Jackson, Sharon D. ; Spellman, Jeanne ; Knopp, Robert H. ; Morgan-Taggart, Ivy ; Tsai, Elaine C. ; Dagogo-Jack, Samuel ; Murphy, Mary E. ; Ricks, Harriet ; Rutledge, Lily M.K. ; Soberman, Judith E. ; Molitch, Mark E. ; Larsen, Diane ; Larkin, Mary ; Bissett, Laurie ; Bondi, Kristy ; D’Anna, Kali ; Delahanty, Linda ; Poulos, Alexandra ; Stevens, Christine ; Hagamen, Susan ; Cantrell, Carolyn M. ; Hadden, Angela ; Roach, Paris J. ; Ratner, Robert E. ; Shapiro, Sue ; Wiggins, Renee ; Saad, Mohammed F. ; Watson, Karol ; Conzues, Claudia ; Ngo, Kathy ; Brown, Angela L. ; Wernimont, Cormarie ; Saudek, Christopher D. ; Brancati, Frederick L. ; Jiggetts, Dawn ; Shade, David S. ; Adams, Karwyn S. ; Adorno, Elsie ; Duffy, Helena ; Goldstein, Angela ; Lukin, Jennifer ; Pompi, Dorothy ; Scheindlin, Jonathan ; Wylie-Rosett, Judith ; Orchard, Trevor ; Kriska, Andrea ; Kramer, M. Kaye ; Guimond, Stephanie ; Semler, Linda ; Isonaga, Mae K. ; Bermudez, Nina E. ; Melish, John S. ; Cooeyate, Norman ; Acton, Kelly J. ; Bucca, Brian C. ; Dodge, Charlotte ; Glass, Martia ; Hanson, Roberta L. ; Ingraham, Louise E. ; Morgan, Tina ; Piromalli, Christopher ; Sangster, Sandra ; Smart, Miranda ; Williams, Rachel ; Larsen, Michael ; Sherif, Hanna ; Bamdad, Julie ; Bezebeh, Tsedenia ; Callaghan, Jackie ; Carter, Caitlin E. ; Christophi, Costas ; Foulkes, Mary ; Lachin, John M. ; Ma, Yong ; Strylewicz, Greg ; Fradkin, Judith ; Garfield, Stanford ; Herman, William H. ; Brändle, Michael
Subjects: Adult ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetes Mellitus, Type 2 - prevention & control ; Diabetes, Gestational - prevention & control ; Disease control ; Fasting ; Female ; Glucose ; Glucose tolerance ; Glucose Tolerance Test ; Health risks ; Humans ; Hypoglycemic Agents - therapeutic use ; Incidence ; Long-term effects ; Metformin ; Metformin - therapeutic use ; Middle Aged ; Pathophysiology/Complications ; Pregnancy ; Prevention ; Research design ; Subgroups
Is Part Of: Diabetes care, 2019-04, Vol.42 (4), p.601-608
Description: We examined the effects of metformin on diabetes prevention and the subgroups that benefited most over 15 years in the Diabetes Prevention Program (DPP) and its follow-up, the Diabetes Prevention Program Outcomes Study (DPPOS). During the DPP (1996-2001), adults at high risk of developing diabetes were randomly assigned to masked placebo ( = 1,082) or metformin 850 mg twice daily ( = 1,073). Participants originally assigned to metformin continued to receive metformin, unmasked, in the DPPOS (2002-present). Ascertainment of diabetes development was based on fasting or 2-h glucose levels after an oral glucose tolerance test or on HbA . Reduction in diabetes incidence with metformin was compared with placebo in subgroups by hazard ratio (HR) and rate differences (RDs). During 15 years of postrandomization follow-up, metformin reduced the incidence (by HR) of diabetes compared to placebo by 17% or 36% based on glucose or HbA levels, respectively. Metformin's effect on the development of glucose-defined diabetes was greater for women with a history of prior gestational diabetes mellitus (GDM) (HR 0.59, RD -4.57 cases/100 person-years) compared with parous women without GDM (HR 0.94, RD -0.38 cases/100 person-years [interaction = 0.03 for HR, = 0.01 for RD]). Metformin also had greater effects, by HR and RD, at higher baseline fasting glucose levels. With diabetes development based on HbA , metformin was more effective in subjects with higher baseline HbA by RD, with metformin RD -1.03 cases/100 person-years with baseline HbA <6.0% (42 mmol/mol) and -3.88 cases/100 person-years with 6.0-6.4% ( = 0.0001). Metformin reduces the development of diabetes over 15 years. The subsets that benefitted the most include subjects with higher baseline fasting glucose or HbA and women with a history of GDM.
Publisher: United States: American Diabetes Association
Language: English
Identifier: ISSN: 0149-5992
EISSN: 1935-5548
DOI: 10.2337/dc18-1970
PMID: 30877090
Source: Geneva Foundation Free Medical Journals at publisher websites
MEDLINE
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Long-term Effects of Metformin on Diabetes Prevention: Identification of Subgroups That Benefited Most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study

2019 by the American Diabetes Association. ;Copyright American Diabetes Association Apr 1, 2019 ;2019 by the American Diabetes Association. 2019 ;ISSN: 0149-5992 ;EISSN: 1935-5548 ;DOI: 10.2337/dc18-1970 ;PMID: 30877090

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