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Metformin and Lifestyle
Intervention Prevents Metabolic Syndrome
posted 04/27/2006
Lifestyle intervention is better
then any drug and along with metformin works to prevent the metabolic syndrome
(MS).
"The metabolic syndrome is a high-risk state for diabetes and cardiovascular
disease," write Trevor J. Orchard, MD, from George Washington University in
Rockville, Maryland, and colleagues from the Diabetes Prevention Program
Coordinating Center. "Little is known about its prevalence and prevention in
those with impaired glucose tolerance."
In the Diabetes Prevention Program taking place at research and community-based centers, participants had IGT defined by World Health Organization criteria plus fasting plasma glucose (FPG) levels at least 5.3 mmol/L (95 mg/dL). After randomization to intensive lifestyle intervention, metformin therapy (850 mg twice daily), or placebo, participants were followed up for a mean of 3.2 years. The lifestyle intervention included a diet designed to achieve and maintain a 7% weight loss, and 150 minutes of exercise per week.
In the group that did not have MS at baseline, both metformin and the lifestyle intervention reduced development of the syndrome. In the group that already had MS at baseline, both lifestyle change and metformin compared with placebo increased the probability that the syndrome would resolve. In both of these groups, the benefit of the lifestyle intervention was larger than the benefit of the drug.
At baseline, 53% of participants (n= 1,711) had the MS, which was defined by
three or more characteristics (waist circumference [WC], blood pressure [BP],
and high-density lipoprotein cholesterol [HDL-C], triglyceride, and FPG levels)
meeting criteria from the National Cholesterol Education Program (NCEP) Adult
Treatment Panel III (ATP III).
The incidence of MS did not vary significantly by age. However, older
participants aged 60 to 82 years were more likely to have low levels of HDL-C.
Compared with placebo, the lifestyle group had 41% lower incidence of the MS
(P < .001), and the metformin group had 17% lower incidence (P = .03) based on
life-table analyses (log-rank test). Three-year cumulative incidence was 51% in
the placebo group, 45% in the metformin group, and 34% in the lifestyle group.
Ethnic group did not significantly affect incidence.
"The metabolic syndrome affected approximately half of the participants in the
Diabetes Prevention Program at baseline," the authors write. "Both lifestyle
intervention and metformin therapy reduced the development of the syndrome in
the remaining participants."
Source: Diabetes In Control: Ann Intern Med. 2005;142:611-619