DPP Continues to Yield Positive Results, New DPPOS Data Show

New results from the Diabetes Prevention Program Outcomes Study (DPPOS), presented at the American Diabetes Association’s 80th Scientific Sessions, showed persistent reductions in type 2 diabetes (T2D) development over an average 22-year follow-up period.

The study is a follow-up to the National Institute of Diabetes and Digestive and Kidney Disease-sponsored Diabetes Prevention Program (DPP), which ran from 1996 to 2001. The DPP ended early as it established implementation of an intensive lifestyle program or metformin treatment reduces diabetes onset in high-risk individuals by 58% and 31%, respectively, compared with placebo. Currently, the FDA does not indicate metformin use for preventive purposes, despite the medication’s approval in other countries.

In 2010, Congress authorized the National Diabetes Prevention Program to address increasing rates of diabetes in the United States. “This national effort created partnerships between public and private organizations to offer evidence-based, cost-effective interventions that help prevent T2D in communities across the United States,” according to the CDC. The National DPP is based off of DPP results and incorporates the proven lifestyle interventions.

Similarly, the Medicare Diabetes Prevention Program (MDPP) launched in 2018 with a goal of expanding access to preventive diabetes practices among at-risk populations. However, a study published this month by The American Journal of Managed Care® found access to MDPP is inadequate, as a lack of suppliers and locations at which individuals can receive services largely hinders the program’s success.

Beginning in 2002, DPPOS began monitoring the more than 2000 individuals initially enrolled in DPP, and now includes 75% of original DPP enrollees. Minority participants make up nearly 50% of the group, making it the largest at-risk population ever studied.

The study aims to evaluate long-term effects of DPP and complications that may have followed participation like retinopathy, nephropathy, and cardiovascular disease (CVD). Average age of DPPOS participants in 2020 is 72 years.

The latest DPPOS findings include:

• Original lifestyle and metformin treatment cohorts continue to have reduced risk of diabetes development compared with the original placebo group at 25% and 18%, respectively
• The single long-term negative effect observed in both interventions was a slight increase in kidney disease in the metformin cohort, only present in the oldest patients
• The intensive lifestyle intervention cohort exhibited long-term reduction in frailty development
• 57% and 37% of participants who did not develop diabetes had a lower risk of developing early changes in eye and kidney disease, respectively
• Of participants who did not develop diabetes, 39% exhibited a lower risk of major cardiovascular disease endpoints (e.g. heart attack)
• In the metformin cohort, favorable trends in stroke reduction and CV events existed in those who began the study before age 45

However, investigators found neither intervention resulted in significant benefits when it comes to development of heart disease, kidney disease, or diabetic retinopathy.

“The current results indicate that prevention of T2D is possible and has important clinical benefits,” said David Nathan, MD, chair of DPPOS and session presenter. “The long-term benefits of the 2 DPP interventions on diabetes development, still present many years after they were started, are a testament to the power of these interventions and reinforce their importance in the reduction of diabetes.”