A lifestyle intervention or metformin prevented or delayed the onset of metabolic syndrome in persons at risk

doi:10.1136/ebm.10.6.172

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Evidence-Based Medicine 2005;10:172; doi:10.1136/ebm.10.6.172
Copyright © 2005 by the BMJ Publishing Group Ltd.

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Therapeutics

A lifestyle intervention or metformin prevented or delayed the onset of metabolic syndrome in persons at risk

Orchard TJ, Temprosa M, Goldberg R, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med 2005;142:611–9.[Abstract/Free Full Text]

Q In persons with impaired glucose tolerance, does an intensive lifestyle intervention (ILS) or treatment with metformin plus standard lifestyle recommendations prevent onset or promote resolution of metabolic syndrome?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ IM/Ambulatory care $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Endocrine $*$ $*$ $*$ $*$ ${star}$ ${star}$ ${star}$

Key Words: diet (reducing) • exercise therapy • metabolic syndrome X • metformin

The first 150 words of the full text of this article appear below.

METHODS
Design: randomised placebo controlled trial (The Diabetes PreventionProgram randomised trial).

Allocation: concealed.^*

Blinding: blinded (clinicians, participants, data collectors, and outcomeassessors for metformin and placebo).^*

Follow-up period: mean 3.2 years.

Setting: 27 centres in the US.

Participants: 3234 participants $>=$ 25 years of age (mean age 51y, 68% women)without diabetes who had a body mass index $>=$ 24 kg/m² ( $>=$ 22 kg/m²for Asian Americans) and a plasma glucose concentration 5.3–7.0mmol/l (95–125 mg/dl) ( $<=$ 7.0 mmol/l [ $<=$ 125 mg/dl] for NativeAmericans) in the fasting state and 7.8–11.1 mmol/l (140–199mg/dl) after a 75 g oral glucose load. 53% of participants hadmetabolic syndrome at baseline.

Intervention: ILS (n = 1079; 530 without metabolic syndrome), standard lifestylerecommendations plus glucose control with metformin (850 mgtwice daily) (n = 1073; 503 without metabolic syndrome), orplacebo (n = 1082; 490 without the metabolic syndrome). TheILS aimed at achieving . . . [Full text of this article]

Ronald J Sigal, MD, MPH, FRCPC

Ottawa Health Research Institute and University of Ottawa
Ottawa, Ontario, Canada