Prevention of type 2 diabetes

Changes in the human environment and in human behavior and lifestyle, in conjunction with genetic susceptibility, have resulted in a dramatic increase in the incidence and prevalence of diabetes in the world. The rapid escalation of the number of people with type 2 diabetes (T2DM) and diabetes-related cardiovascular disease demands urgent action on prevention. The Finnish Diabetes Prevention Study and The Diabetes Prevention Program showed that the prevention (or delaying) of T2DM is feasible and effective. Both of these trials led to a reduction of 58% in the conversion to diabetes in subjects with impaired glucose tolerance. Compared to lifestyle changes, drug treatment in the prevention of diabetes in people at high risk for T2DM has been less beneficial. Metformin (31%) or acarbose (25%) treatment obtained only about a half of the reduction in the conversion to diabetes compared to lifestyle changes. These drugs require monitoring, and have significant side-effects. Also the effect of orlistat (37%) did not reach the effect of lifestyle modification. Results of the Troglitazone in Prevention of Diabetes study are suggestive for the prevention, but the trial was too small, and included only one ethnic group (Hispanic) and one gender (women). On the basis of the evidence available, we do not have a definite proof that T2DM is prevented in any of these trials. However, we can safely conclude that the current evidence strongly favors the notion that lifestyle changes are the primary means to tackle the epidemic of T2DM.     

Evaluating the Cost-Effectiveness of Lifestyle Modification versus Metformin Therapy for the Prevention of Diabetes in Singapore

BackgroundIn Singapore, as diabetes is an increasingly important public health issue, the cost-effectiveness of pursuing lifestyle modification programs and/or alternative prevention strategies is of critical importance for policymakers. While the US Diabetes Prevention Program (DPP) compared weight loss through lifestyle modification with oral treatment of diabetes drug metformin to prevent/delay the onset of type 2 diabetes in pre-diabetic subjects, no data on either the actual or potential cost effectiveness of such a program is available for East or South-east Asian populations. This study estimates the 3-year cost-effectiveness of lifestyle modification and metformin among pre-diabetic subjects from a Singapore health system and societal perspective.MethodologyCost effectiveness was analysed from 2010–2012 using a decision-based model to estimate the rates of getting diabetes, healthcare costs and health-related quality of life. Cost per quality-adjusted life year (QALY) was estimated using costs relevant to the time horizon of the study from Singapore. All costs are expressed in 2012 US dollars.ConclusionBased on adaptation of the DPP data to local conditions, both lifestyle modification and metformin intervention are likely to be cost-effective and worth implementing in Singapore to prevent or delay the onset of type 2 diabetes. However, the cost of lifestyle modification from the societal perspective would have to be reduced in order to match the cost-effectiveness of metformin intervention.     

Diabetes prevention--from physiology to implementation.

One of the major challenges today is the development of prevention programs for the clinical practice. Our aim was to develop a concept for a primary diabetes prevention program to be implemented in general health care. Lifestyle intervention addressing diet and exercise has reduced the diabetes risk by up to 58%. Early preventive pharmacological strategies have yielded a diabetes risk reduction of 25-30%. These findings offer a compelling evidence base, but delivery of intervention and care is essential. The challenge therefore is the management of prevention and intervention programs considering scientific aspects and practical requirements during implementation. The Diabetes Prevention Workgroup at the German Diabetes Association has developed a concept for a decentralized prevention program. Based on the results of the prevention studies, the intervention concept consists of a three-step program including identification of the individuals at high risk to develop type 2 diabetes (1), followed by general intervention based on individual choice (2) and maintained continuous intervention for motivation maintenance (3). Structured prevention programs will enable nationwide prevention of diabetes mellitus without consuming large resources. This process will be challenging and time consuming, requiring many partners but resulting in a profitable "health" investment.     

The new clinical trials with thiazolidinediones--DREAM, ADOPT, and CHICAGO: promises fulfilled?

PURPOSE OF REVIEW: Despite extensive documentation of their insulin-sensitizing and antihyperglycemic effects, the importance and place of the thiazolidinediones in diabetes management remain unclear. Three new controlled clinical trials of thiazolidinediones offer new information on the clinical utility of these agents. RECENT FINDINGS: During the past year, three new trials of thiazolidinediones were reported. In Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication, rosiglitazone reduced progression to diabetes in prediabetic patients by 60%. A Diabetes Outcome Progression Trial found rosiglitazone to have greater antihyperglycemic durability than metformin and glyburide in patients with recently diagnosed type 2 diabetes. Finally, in the Carotid Intima-media Thickness in Atherosclerosis using Pioglitazone, treatment with pioglitazone in patients with type 2 diabetes slowed progression of carotid wall thickness compared with the sulfonylurea glimepiride. SUMMARY: These trials support the contention that thiazolidinediones have superior efficacy in improving and stabilizing glycemic control than older antihyperglycemic agents, especially early in the course of type 2 diabetes. Findings from the Carotid Intima-media Thickness in Atherosclerosis using Pioglitazone add to the evidence that these agents have clinically meaningful vasculoprotective effects. Although generally well tolerated, they promote weight gain, limiting their acceptability to some extent, and occasionally lead to a diagnosis of heart failure, mostly in susceptible individuals.     

Effects of Genetic Variants Previously Associated with Fasting Glucose and Insulin in the Diabetes Prevention Program

Common genetic variants have been recently associated with fasting glucose and insulin levels in white populations. Whether these associations replicate in pre-diabetes is not known. We extended these findings to the Diabetes Prevention Program, a clinical trial in which participants at high risk for diabetes were randomized to placebo, lifestyle modification or metformin for diabetes prevention. We genotyped previously reported polymorphisms (or their proxies) in/near G6PC2, MTNR1B, GCK, DGKB, GCKR, ADCY5, MADD, CRY2, ADRA2A, FADS1, PROX1, SLC2A2, GLIS3, C2CD4B, IGF1, and IRS1 in 3,548 Diabetes Prevention Program participants. We analyzed variants for association with baseline glycemic traits, incident diabetes and their interaction with response to metformin or lifestyle intervention. We replicated associations with fasting glucose at MTNR1B (P<0.001), G6PC2 (P = 0.002) and GCKR (P = 0.001). We noted impaired β-cell function in carriers of glucose-raising alleles at MTNR1B (P<0.001), and an increase in the insulinogenic index for the glucose-raising allele at G6PC2 (P<0.001). The association of MTNR1B with fasting glucose and impaired β-cell function persisted at 1 year despite adjustment for the baseline trait, indicating a sustained deleterious effect at this locus. We also replicated the association of MADD with fasting proinsulin levels (P<0.001). We detected no significant impact of these variants on diabetes incidence or interaction with preventive interventions. The association of several polymorphisms with quantitative glycemic traits is replicated in a cohort of high-risk persons. These variants do not have a detectable impact on diabetes incidence or response to metformin or lifestyle modification in the Diabetes Prevention Program.     

The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it

The Look AHEAD (Action for Health in Diabetes) study is a multicenter, randomized controlled trial designed to determine whether intentional weight loss reduces cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes. The study began in 2001 and is scheduled to conclude in 2012. A total of 5145 participants have been randomly assigned to a lifestyle intervention or to an enhanced usual care condition (i.e., diabetes support and education). This article describes the lifestyle intervention and the empirical evidence to support it. The two principal intervention goals are to induce a mean loss >or = 7% of initial weight and to increase participants' moderately intense physical activity to > or =175 min/wk. For the first 6 months, participants attend one individual and three group sessions per month and are encouraged to replace two meals and one snack a day with liquid shakes and meal bars. From months 7 to 12, they attend one individual and two group meetings per month and continue to replace one meal per day (which is recommended for the study's duration). Starting at month 7, more intensive behavioral interventions and weight loss medication are available from a toolbox, designed to help participants with limited weight loss. In Years 2 to 4, treatment is provided mainly on an individual basis and includes at least one on-site visit per month and a second contact by telephone, mail, or e-mail. After Year 4, participants are offered monthly individual visits. The intervention is delivered by a multidisciplinary team that includes medical staff who monitor participants at risk of hypoglycemic episodes.     

Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in US Settings: A Systematic Review and Meta-analysis

BackgroundThe Diabetes Prevention Program (DPP) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States.ConclusionsDPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective.     

To screen or not to screen for pre-type 1 diabetes?

The incidence of type 1 diabetes is increasing worldwide and the disease is an onerous burden both to the individual and to society. There are thus important reasons to screen for the disease before it becomes manifest: (1) to improve understanding of the natural history of the prediabetic period; (2) to gain further insights into the immunopathogenesis of the disease; (3) to identify individuals for prevention trials; (4) to make an earlier diagnosis in order to reduce morbidity and mortality. Great strides have been made, yet there is still a great deal to be learned. Opponents of screening argue that screening tests for the disease have a low positive predictive value and that predicting the disease without a primary prevention capability raises ethical considerations because of induced stress, lifestyle changes, cost and potential effects on insurability. The greatest single barrier against large-scale population screening and prevention of the disease remains the lack of an effective intervention. However, screening in the context of well-designed research studies must continue - ultimately the benefit to the individual and to society will be immense.     

Leukocyte telomere length in the Finnish Diabetes Prevention Study

Leukocyte telomere length (TL) is considered a biomarker for biological aging. Shortened TL has been observed in many complex diseases, including type 2 diabetes (T2DM). Lifestyle intervention studies, e.g. the Diabetes Prevention Study (DPS), have shown a decrease in the incidence of T2DM by promoting healthy lifestyles in individuals with impaired glucose tolerance (IGT). Our aim was to study in the DPS the influence of the lifestyle intervention on TL. TL was measured by quantitative PCR-based method at two time points (N = 334 and 343) on average 4.5 years apart during the active intervention and post-intervention follow-up. TL inversely correlated with age. Our main finding was that TL increased in about two thirds of the individuals both in the intervention and in the control groups during follow-up; TL increased most in individuals with the shortest TL at the first measurement. TL was not associated with development of T2DM, nor did lifestyle intervention have an effect on TL. No association between insulin secretion or insulin resistance indices and TL was observed. We did not detect an association between TL and development of T2DM in the DPS participants. It could be due to all participants being overweight and having IGT at baseline, both of which have been found to be independently associated with shorter leukocyte TL in some earlier studies. TL had no substantial role in worsening of glucose tolerance in people with IGT. Our study confirms that leukocyte TL can increase with time even in obese people with impaired glucose metabolism.     

Different screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis

Background

Obesity and asthma have reached epidemic proportions in the US. Their concurrent rise over the last 30 years suggests that they may be connected. Numerous observational studies support a temporally-correct, dose-response relationship between body mass index (BMI) and incident asthma. Weight loss, either induced by surgery or caloric restriction, has been reported to improve asthma symptoms and lung function. Due to methodological shortcomings of previous studies, however, well-controlled trials are needed to investigate the efficacy of weight loss strategies to improve asthma control in obese individuals.

Methods/Design

BE WELL is a 2-arm parallel randomized clinical trial (RCT) of the efficacy of an evidence-based, comprehensive, behavioral weight loss intervention, focusing on diet, physical activity, and behavioral therapy, as adjunct therapy to usual care in the management of asthma in obese adults. Trial participants (n = 324) are patients aged 18 to 70 years who have suboptimally controlled, persistent asthma, BMI between 30.0 and 44.9 kg/m², and who do not have serious comorbidities (e.g., diabetes, heart disease, stroke). The 12-month weight loss intervention to be studied is based on the principles of the highly successful Diabetes Prevention Program lifestyle intervention. Intervention participants will attend 13 weekly group sessions over a four-month period, followed by two monthly individual sessions, and will then receive individualized counseling primarily by phone, at least bi-monthly, for the remainder of the intervention. Follow-up assessment will occur at six and 12 months. The primary outcome variable is the overall score on the Juniper Asthma Control Questionnaire measured at 12 months. Secondary outcomes include lung function, asthma-specific and general quality of life, asthma medication use, asthma-related and total health care utilization. Potential mediators (e.g., weight loss and change in physical activity level and nutrient intake) and moderators (e.g., socio-demographic characteristics and comorbidities) of the intervention effects also will be examined.

Discussion

This RCT holds considerable potential for illuminating the nature of the obesity-asthma relationship and advancing current guidelines for treating obese adults with asthma, which may lead to reduced morbidity and mortality related to the comorbidity of the two disorders.

Trial registration

NCT00901095     

Anti-Obesity Pharmacotherapy and the Potential for Preventing Progression from Prediabetes to Type 2 Diabetes

Objective: Type 2 diabetes and its associated complications place heavy burdens on affected individuals, their caregivers, and society. The prevalence of type 2 diabetes is increasing worldwide. Attempts to combat this problem have been extended to the treatment of obesity and prevention of progression from prediabetes to type 2 diabetes. As such, weight loss is an important component of type 2 diabetes prevention. However, successful strategies for achieving sustained weight loss have remained elusive. Although lifestyle modification remains a cornerstone of this approach, it has become clear that changes to lifestyle alone will not suffice for many patients. A pragmatic approach includes consideration of pharmacotherapeutic options.Methods: This review discusses the different pharmacotherapeutic options for the treatment of obesity and prediabetes.Results: Approved anti-obesity therapies and antihyperglycemic agents associated with weight loss may prove effective earlier in the treatment paradigm, and other promising agents that are in clinical development for chronic weight management show promise for both weight reduction and a reduction in the risk of type 2 diabetes in high-risk individuals.Conclusion: Long-term evaluation of safety and efficacy is required for many of these agents before we can begin to optimize their use in clinical practice, but treatment choices for obese or prediabetic patients are increasing.Abbreviations: AACE = American Association of Clinical Endocrinologists ADA = American Diabetes Association AE = adverse event AMA = American Medical Association BMI = body mass index CI = confidence interval CR = controlled release DPP = Diabetes Prevention Program IFG = impaired fasting glucose IGT = impaired glucose tolerance FDA = Food and Drug Administration FPG = fasting plasma glucose GLP-1 = glucagon-like peptide-1 GLP-1 RA = glucagon-like peptide-1 receptor agonist HbA_1c= glycosylated hemoglobin ITT-LOCF = intention-totreat with last observation carried forward LS = least squares NB = naltrexone/bupropion OR = odds ratio PHEN = phentermine PYE = patient years of exposure PYY = peptide YY SGLT-2 = sodium glucose cotransporter 2 TPM = topiramate TZD = thiazolidinedione     

The Impact of Diabetes Education on Improving Patient Outcomes

Background: Diabetes education provided by certified diabetes educators (CDEs) can help improve the lives of patients with diabetes mellitus (DM). With morbidity, mortality, and medical costs of increasing concern, diabetes educators must provide patients and primary caregivers with the tools to improve their DM and the motivation and understanding to help them meet their goals.Objective: The goal of this article was to determine the effectiveness of education provided by CDEs in an American Diabetes Association-recognized outpatient program for adults.Methods: Review of the literature from 2003 to 2006 was undertaken using the search terms diabetes education, efficacy of lifestyle education, AIC reduction, and certified diabetes educators. Landmark studies such as the Diabetes Control and Complications Trial, the United Kingdom Prospective Diabetes Study, and the Diabetes Prevention Program were also cited. The staff at Saint Joseph's Hospital, Center for Diabetes Care, developed a questionnaire to ascertain how patients were managing key indicators related to DM. Data were gathered on patients who had both an initial visit (IV) during 2003 and 2004 and a follow-up visit (FUV) that typically took place 4.5 months later. During their IV, patients were assessed, provided with basic information, and set goals. They then participated in 2 subsequent classes within the next few months on DM self-management and returned for the FUV The questionnaire was completed at both the IV and FUV The answers were blinded. Data were examined to determine if diabetes education provided by CDEs changed patient behaviors and decreased glycosylated hemoglobin (A1C) values.Results: A total of 501 patients had an IV and an FUV Between visits, mean AlC level decreased significantly from 7.9% to 6.7%; mean weight decreased significantly from 198.6 to 196.0 lb; systolic blood pressure decreased from 132.8 to 131.5 mm Hg and diastolic blood pressure decreased from 79.4 to 77.1 mm Hg; medication adherence increased from 5% to 21% for 4 classes of medication; exercise increased from 58% (284) to 80% (403) of patients; and self-monitoring of blood glucose levels increased from 53% (260) to 98% (476) of patients. More than half of the 89% (446) of patients who set goals at the W met their goals.Conclusion: The diabetes education provided by CDEs helped patients adopt the healthier lifestyle behaviors needed to control their DM and to reduce their AlC levels.     

Four-year weight losses in the Look AHEAD study: factors associated with long-term success

This report provides a further analysis of the year 4 weight losses in the Look AHEAD (Action for Health in Diabetes) study and identifies factors associated with long-term success. A total of 5,145 overweight/obese men and women with type 2 diabetes were randomly assigned to an intensive lifestyle intervention (ILI) or a usual care group, referred to as Diabetes Support and Education (DSE). ILI participants were provided approximately weekly group or individual treatment in year 1; continued but less frequent contact was provided in years 2-4. DSE participants received three group educational sessions in all years. As reported previously, at year 4, ILI participants lost an average of 4.7% of initial weight, compared with 1.1% for DSE (P < 0.0001). More ILI than DSE participants lost ≥ 5% (46% vs. 25%, P < 0.0001) and ≥ 10% (23% vs. 10%, P < 0.0001) of initial weight. Within the ILI, achievement of both the 5% and 10% categorical weight losses at year 4 was strongly related to meeting these goals at year 1. A total of 887 participants in ILI lost ≥ 10% at year 1, of whom 374 (42.2%) achieved this loss at year 4. Participants who maintained the loss, compared with those who did not, attended more treatment sessions and reported more favorable physical activity and food intake at year 4. These results provide critical evidence that a comprehensive lifestyle intervention can induce clinically significant weight loss (i.e., ≥ 5%) in overweight/obese participants with type 2 diabetes and maintain this loss in more than 45% of patients at 4 years.     

Fibrates, dyslipoproteinaemia and cardiovascular disease

Recent epidemiological data have reaffirmed that elevated plasma triglyceride and low HDL-cholesterol levels are important risk factors for atherosclerotic vascular disease. The rationale for the clinical use of fibric acid derivatives, which are designed to correct this metabolic nexus, is now on firmer ground. The mechanism of action of fibrates on lipoprotein metabolism has recently been elucidated at the molecular level and involves the activation of peroxisome proliferator-activated receptor-alpha 1 in the liver, with the net effect of improving the plasma transport rates of several lipoproteins. Other potential anti-atherothrombotic effects include the inhibition of coagulation and enhancement of fibrinolysis, as well as the inhibition of inflammatory mediators involved in atherogenesis. These consequences probably underpin the favourable effects of fibrates seen in recent angiographic and clinical trials. Two important clinical trials on the effect of gemfibrozil (Veterans Administration-HDL-Cholesterol Intervention Trial) and bezafibrate (Bezafibrate Infarction Prevention Study) have recently been completed in subjects with elevated triglyceride, low HDL and normal or near-normal LDL-cholesterol levels. The results testify to the efficacy of these agents in decreasing the incidence of cardiovascular events, particularly in patients with multiple risk factors and plasma triglyceride levels of over 2.2 mmol/l. The findings of these trials are compared with the statin-based Air Force/Texas Coronary Atherosclerosis Prevention Study, with a recommendation that future studies in appropriately selected patients should examine the synergistic effect of the fibrate/statin combination. The absolute risk reduction in the incidence of coronary events in the Veterans Administration-HDL-Cholesterol Intervention Trial compares favourably with the statin trials. The therapeutic aspects of the efficacy and safety of fibrates are reviewed. Besides primary mixed hyperlipidaemias, particular indications for the clinical use of fibrates include type 2 diabetes, the metabolic syndrome and renal insufficiency. The St Mary's, Ealing, Northwick Park Diabetes Cardiovascular Disease Prevention Study has suggested that fibrates may decrease the incidence of coronary events in type 2 diabetes, but this hypothesis will be more extensively tested in the Diabetes Atherosclerosis Intervention Study, Fenofibrate in Event Lowering in Diabetes Study and Lipids in Diabetes Study projects. Although significant new knowledge has accrued over the past few years concerning the fundamental and clinical aspects of fibrates, the success of these agents in clinical practice depends on the availability of methods for assessing cardiovascular risk as well as on treatment guidelines, which as presently designed and recommended may be inaccurate and suboptimal.     

Appropriate,timely, and rational treatment of type 2 diabetes mellitus: Meeting the challenges of primary care

Diabetes now affects >24 million people in the United States. As the prevalence of diabetes continues to increase, long-term complications of diabetes have emerged as major health care issues. Although much focus has been placed on diabetes, it is important to note that prediabetes, the intermediate state of type 2 diabetes mellitus (DM), is not benign. The progression to type 2 DM for patients with impaired glucose tolerance (IGT) is 6% to 10% per year; for persons with both impaired fasting glucose and IGT, the cumulative incidence of diabetes in 6 years may be as high as 60%. Given the significant clinical and financial impact of both conditions, it is vital that clinicians initiate treatment of diabetes and prediabetes early and aggressively. Despite advances in diabetes treatment, many health care providers do not initiate or intensify therapy appropriately during patient visits, which contributes to poor diabetes control. Although management of blood pressure and lipid levels can be complex, glycemic control is often problematic for patients and their clinicians. Thus, clinicians must learn to use the various pharmacologic and nonpharmacologic strategies effectively to achieve glucose targets in their patients with type 2 DM. Patients with prediabetes should be managed with a combination of lifestyle intervention and appropriately timed pharmacotherapy. Pancreatic β-cell preservation should be a primary metabolic target.     

Evaluation of a mathematical model of diabetes progression against observations in the Diabetes Prevention Program

The seminal publication of the Diabetes Prevention Program (DPP) results in 2002 has provided insight into the impact of major therapies on the development of diabetes over a time span of a few years. In the present work, the publicly available DPP data set is used to calibrate and evaluate a recently developed mechanistic mathematical model for the long-term development of diabetes to assess the model's ability to predict the natural history of disease progression and the effectiveness of preventive interventions. A general population is generated from which virtual subject samples corresponding to the DPP enrollment criteria are selected. The model is able to reproduce with good fidelity the observed time courses of both diabetes incidence and average glycemia, under realistic hypotheses on evolution of disease and efficacy of the studied therapies, for all treatment arms. Model-based simulations of the long-term evolution of the disease are consistent with the transient benefits observed with conventional therapies and with promising effects of radical improvement of insulin sensitivity (as by metabolic surgery) or of β-cell protection. The mechanistic diabetes progression model provides a credible tool by which long-term implications of antidiabetic interventions can be evaluated.     

The European perspective of diabetes prevention

The dramatic increase in newly diagnosed cases of type 2 diabetes is a major public health concern within the European Union. However, it has been demonstrated that prevention programmes can significantly reduce the risk of developing diabetes. There is a clear consensus amongst healthcare professionals that action is urgently needed at both EU and community levels. The challenge is to implement proven intervention methods effectively into clinical reality. To achieve this, action is needed not only in the field of policy development but also in the development of targeted intervention programmes, which address the needs of people with an increased diabetes risk, clinical- and community-based healthcare professionals, and the general population. The Diabetes Prevention Forum (DPF), founded by the European region of the International Diabetes Federation, consists of European diabetes experts from a range of backgrounds. The DPF is taking immediate action to co-ordinate and improve the information flow between all relevant stakeholders to enable more effective communication, so helping to improve the ability to prevent type 2 diabetes in Europe.     

Achieving Weight and Activity Goals Among Diabetes Prevention Program Lifestyle Participants

Objective: The Diabetes Prevention Program (DPP) showed that intensive lifestyle intervention reduced the risk of diabetes by 58%. This paper examines demographic, psychosocial, and behavioral factors related to achieving weight loss and physical activity goals in the DPP lifestyle participants. Research Methods and Procedures: Lifestyle participants (n = 1079; mean age = 50.6, BMI = 33.9, 68% female, and 46% from minority groups) had goals of 7% weight loss and 150 min/wk of physical activity. Goal achievement was assessed at the end of the 16‐session core curriculum (approximately week 24) and the final intervention visit (mean = 3.2 years) as a function of demographic, psychosocial, and behavioral variables. Results: Forty‐nine percent met the weight loss goal and 74% met the activity goal initially, while 37% and 67%, respectively, met these goals long‐term. Men and those with lower initial BMI were more likely to meet activity but not weight loss goals. Hispanic, Asian, and Native Americans were more likely to meet the long‐term activity goals, and whites were more likely to meet the initial weight loss goal. In multivariate analyses, meeting the long‐term weight loss goal and both activity goals increased with age, while psychosocial and depression measures were unrelated to goal achievement. Dietary self‐monitoring was positively related to meeting both weight loss and activity goals, and meeting the activity goal was positively related to meeting the weight loss goal. Participants who met initial goals were 1.5 to 3.0 times more likely to meet these goals long‐term. Discussion: Success at meeting the weight loss and activity goals increased with age. Initial success predicted long‐term success. Self‐monitoring and meeting activity goals were related to achieving and sustaining weight loss.     

Weight loss of black, white, and Hispanic men and women in the Diabetes Prevention Program

Objective: To provide the specific weight loss outcomes for African‐American, Hispanic, and white men and women in the lifestyle and metformin treatment arms of the Diabetes Prevention Program (DPP) by race‐gender group to facilitate researchers translating similar interventions to minority populations, as well as provide realistic weight loss expectations for clinicians. Methods and Procedures: Secondary analyses of weight loss of 2,921 overweight participants (22% black; 17% Hispanic; 61% white; and 68% women) with impaired glucose tolerance randomized in the DPP to intensive lifestyle modification, metformin or placebo. Data over a 30‐month period are examined for comparability across treatment arms by race and gender. Results: Within lifestyle treatment, all race‐gender groups lost comparable amounts of weight with the exception of black women who exhibited significantly smaller weight losses (P < 0.01). For example, at 12 months, weight losses for white men (?8.4%), white women (?8.1%), Hispanic men (?7.8%), Hispanic women (?7.1%), and black men (?7.1%) were similar and significantly higher than black women (?4.5%). In contrast, within metformin treatment, all race‐gender groups including black women lost similar amounts of weight. Race‐gender specific mean weight loss data are provided by treatment arm for each follow‐up period. Discussion: Diminished weight losses were apparent among black women in comparison with other race‐gender groups in a lifestyle intervention but not metformin, underscoring the critical nature of examining sociocultural and environmental contributors to successful lifestyle intervention for black women.