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Among adults who lost at least 5% of their baseline weight in the first year of the historic diabetes prevention program, those who were badigned to metformin treatment continued to lose weight more important between Grade 6 and Grade 15 compared to participants badigned to a placebo intervention, according to a post hoc badysis published in the journal Annals of Internal Medicine.
Kishore Gadde
"We concluded that although the Diabetes Prevention Program (DPP) initially had a beneficial effect on lifestyle treatment, metformin appeared to be more effective at maintaining weight loss," he says. Kishore Gadde, MD, Fairfax Foster Bailey Chair in Heart Disease Prevention and Medical Director of Clinical Services at the Pennington Biomedical Research Center at Louisiana State University, stated Endocrine today. "This finding has become increasingly important over the years. There was something striking about it. "
Gadde and colleagues badyzed data from 1,066 participants from 27 clinics who lost at least 5% of their baseline weight in the first year of the PLR program, a randomized controlled trial comparing weight loss to metformin (850 mg twice a day) and an intensive lifestyle intervention. (16 behavior modification sessions over 6 to 8 months) or placebo in adults with prediabetes and overweight or obesity between 1996 and 2001. Once the masked treatment phase ended, the researchers followed the participants to the current study on the results of the DPP, which began in 2002. until 2013. The researchers used fixed-effect models to determine the percentage of weight loss over time and models of 39 generalized estimating equation to determine the percentage of participants with long-term weight loss in those who lost at least 5% of their body weight in the first year. . Researchers used logistic regression models to estimate predictors of weight loss in the medium term (5 years), long term (10 years) and very long term (15 years).
At 1 year, 289 participants in the metformin group (28.5%), 640 participants in the lifestyle intervention group (62.6%) and 137 participants in the placebo group (13.4%) lost at least 5% of their initial body weight. The mean 1-year weight loss of metformin, lifestyle, and placebo participants was 8.9% (95% CI, 8.5-9.3), 11% (95% CI, 10%). , 6 to 11.4) and 9.2% (95% CI, 8.3-10.1), respectively, according to the researchers.
The researchers found that the average weight loss from baseline between years 2 and 15 ranged from 5.8% to 8.2% in the metformin group, from 3.4% to 8.9% in the group lifestyle and 1.6% to 5.8% in the placebo group. However, between years 6 and 15 – after lifestyle intervention – the mean weight loss from baseline was 6.2% (95% CI, 5.2 to 7.2) in the metformin group, 3.7% in the lifestyle group (95% CI, 3.1). -4.4) and 2.8% (95% CI, 1.3-4.4) in the placebo group.
"The [intensive lifestyle] group had the highest percentage (74%) of participants who lost at least 5% in the second year, but this percentage decreased from 51% to 62% in years 3 to 5 and from 41% to 47% in years 6 to 15, "said the researchers. wrote. "On the other hand, the percentage of people who lost at least 5% went from 61% in the second year to 54% to 57% in the years 3 to 5 and from 51% to 64% in the years 6 to 15 of the group. metformin and 49% in years 2 to 35% to 43% years 3 to 5 and 35% to 50% years 6 to 15 in the placebo group. "
The researchers also noted that cumulative incidence rates of diabetes over the 15 years of follow-up were lower among those who had lost at least 5% of their body weight in the first year.
Predictors of long-term weight loss
The researchers found that independent predictors of long-term weight loss included greater weight loss in the first year in all groups; the age and continued use of metformin in the metformin group; advanced age and absence of diabetes or family history of diabetes in the lifestyle intervention group; and higher fasting plasma glucose levels in the placebo group.
The researchers found that the average weight loss from baseline between years 2 and 15 ranged from 5.8% to 8.2% in the metformin group, from 3.4% to 8.9% in the group lifestyle and 1.6% to 5.8% in the placebo group.
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"If you are a person who loses 5% with metformin, you maintain this weight loss for a very long time," Gadde said in an interview. "Metformin is not intended to induce initial weight loss. Future surveys should look at whether we could get people to lose weight with food intervention or a prescription weight loss agent … to get a good start, and then keep them on metformin. It is an attractive medicine because it is inexpensive and safe. "
The mechanisms that contribute to the effects of metformin on body weight are not well understood, said Gadde, who noted that decreased appetite and food intake with metformin had been reported in some studies.
"We do not know (the mechanism)," said Gadde. "It can modulate the centers of regulation of hypothalamic appetite. This can affect the signaling of appetite control. This could work by altering the intestinal microbiome. It could also be reversing the consequences of aging. "
Limits of study
In the commentary accompanying the study, Leslie I. Katzel, MD, PhD, and John D. Sorkin, MD, PhD, Both members of the Faculty of Medicine at the University of Maryland in Baltimore noted that the evaluation of the study results had to take into account several limitations. The interpretation of the percentage of patients who have achieved and maintained a 5% weight loss is difficult because of the regression to the average, they wrote, while the number of patients in the life and placebo group having Metformin intake increased over time, and compliance with metformin treatment was reduced from 72% during DPP to 49% in DPPOS.
"Although a greater proportion of participants in the metformin group maintained a weight loss of at least 5% over the 15 years of follow-up, more participants lost at least 5% over the course of 15 years. years of follow-up. [intensive lifestyle] group because more of this group achieved the goal of weight loss the first year, despite a lower retention rate, "wrote Katzel and Sorkin. "In addition to the limitations mentioned above, this prevents the present study from answering the question of which therapy is best in the long term."
Katzel and Sorkin added that, for the time being, clinical judgment should be used to decide if metformin should be added when the lifestyle intervention does not give the expected results or when the patient regains weight that he lost. – by Regina Schaffer
For more information:
Kishore Gadde, MD, can be reached at the Center for Biostatistics at George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852; email: [email protected].
reclosings : Gadde says he has received grants from AstraZeneca and BioKer, as well as other help from AstraZeneca and the American Diabetes Association. Katzel and Sorkin do not report any relevant financial information. Please consult the study for the relevant financial information of all other authors.
Among adults who lost at least 5% of their baseline weight in the first year of the historic diabetes prevention program, those who were badigned to metformin treatment continued to lose weight more important between Grade 6 and Grade 15 compared to participants badigned to a placebo intervention, according to a post hoc badysis published in the journal Annals of Internal Medicine.
Kishore Gadde
"We concluded that although the Diabetes Prevention Program (DPP) initially had a beneficial effect on lifestyle treatment, metformin appeared to be more effective at maintaining weight loss," he says. Kishore Gadde, MD, Fairfax Foster Bailey Chair in Heart Disease Prevention and Medical Director of Clinical Services at the Pennington Biomedical Research Center at Louisiana State University, stated Endocrine today. "This finding has become increasingly important over the years. There was something striking about it. "
Gadde and colleagues badyzed data from 1,066 participants from 27 clinics who lost at least 5% of their baseline weight in the first year of the PLR program, a randomized controlled trial comparing weight loss to metformin (850 mg twice a day) and an intensive lifestyle intervention. (16 behavior modification sessions over 6 to 8 months) or placebo in adults with prediabetes and overweight or obesity between 1996 and 2001. Once the masked treatment phase ended, the researchers followed the participants to the current study on the results of the DPP, which began in 2002. until 2013. The researchers used fixed-effect models to determine the percentage of weight loss over time and models of 39 generalized estimating equation to determine the percentage of participants with long-term weight loss in those who lost at least 5% of their body weight in the first year. . Researchers used logistic regression models to estimate predictors of weight loss in the medium term (5 years), long term (10 years) and very long term (15 years).
At 1 year, 289 participants in the metformin group (28.5%), 640 participants in the lifestyle intervention group (62.6%) and 137 participants in the placebo group (13.4%) lost at least 5% of their initial body weight. The mean 1-year weight loss of metformin, lifestyle, and placebo participants was 8.9% (95% CI, 8.5-9.3), 11% (95% CI, 10%). , 6 to 11.4) and 9.2% (95% CI, 8.3-10.1), respectively, according to the researchers.
The researchers found that the average weight loss from baseline between years 2 and 15 ranged from 5.8% to 8.2% in the metformin group, from 3.4% to 8.9% in the group lifestyle and 1.6% to 5.8% in the placebo group. However, between years 6 and 15 – after lifestyle intervention – the mean weight loss from baseline was 6.2% (95% CI, 5.2 to 7.2) in the metformin group, 3.7% in the lifestyle group (95% CI, 3.1). -4.4) and 2.8% (95% CI, 1.3-4.4) in the placebo group.
PAGE BREAK
"The [intensive lifestyle] group had the highest percentage (74%) of participants who lost at least 5% in the second year, but this percentage decreased from 51% to 62% in years 3 to 5 and from 41% to 47% in years 6 to 15, "said the researchers. wrote. "On the other hand, the percentage of people who lost at least 5% went from 61% in the second year to 54% to 57% in the years 3 to 5 and from 51% to 64% in the years 6 to 15 of the group. metformin and 49% in years 2 to 35% to 43% years 3 to 5 and 35% to 50% years 6 to 15 in the placebo group. "
The researchers also noted that cumulative incidence rates of diabetes over the 15 years of follow-up were lower among those who had lost at least 5% of their body weight in the first year.
Predictors of long-term weight loss
The researchers found that independent predictors of long-term weight loss included greater weight loss in the first year in all groups; the age and continued use of metformin in the metformin group; advanced age and absence of diabetes or family history of diabetes in the lifestyle intervention group; and higher fasting plasma glucose levels in the placebo group.
The researchers found that the average weight loss from baseline between years 2 and 15 ranged from 5.8% to 8.2% in the metformin group, from 3.4% to 8.9% in the group lifestyle and 1.6% to 5.8% in the placebo group.
Adobe Stock
"If you are a person who loses 5% with metformin, you maintain this weight loss for a very long time," Gadde said in an interview. "Metformin is not intended to induce initial weight loss. Future surveys should look at whether we could get people to lose weight with food intervention or a prescription weight loss agent … to get a good start, and then keep them on metformin. It is an attractive medicine because it is inexpensive and safe. "
The mechanisms that contribute to the effects of metformin on body weight are not well understood, said Gadde, who noted that decreased appetite and food intake with metformin had been reported in some studies.
"We do not know (the mechanism)," said Gadde. "It can modulate the centers of regulation of hypothalamic appetite. This can affect the signaling of appetite control. This could work by altering the intestinal microbiome. It could also be reversing the consequences of aging. "
Limits of study
In the commentary accompanying the study, Leslie I. Katzel, MD, PhD, and John D. Sorkin, MD, PhD, Both members of the Faculty of Medicine at the University of Maryland in Baltimore noted that the evaluation of the study results had to take into account several limitations. The interpretation of the percentage of patients who have achieved and maintained a 5% weight loss is difficult because of the regression to the average, they wrote, while the number of patients in the life and placebo group having Metformin intake increased over time, and compliance with metformin treatment was reduced from 72% during DPP to 49% in DPPOS.
PAGE BREAK
"Although a greater proportion of participants in the metformin group maintained a weight loss of at least 5% over the 15 years of follow-up, more participants lost at least 5% over the course of 15 years. years of follow-up. [intensive lifestyle] group because more of this group achieved the goal of weight loss the first year, despite a lower retention rate, "wrote Katzel and Sorkin. "In addition to the limitations mentioned above, this prevents the present study from answering the question of which therapy is best in the long term."
Katzel and Sorkin added that, for the time being, clinical judgment should be used to decide if metformin should be added when the lifestyle intervention does not give the expected results or when the patient regains weight that he lost. – by Regina Schaffer
For more information:
Kishore Gadde, MD, can be reached at the Center for Biostatistics at George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852; email: [email protected].
reclosings : Gadde says he has received grants from AstraZeneca and BioKer, as well as other help from AstraZeneca and the American Diabetes Association. Katzel and Sorkin do not report any relevant financial information. Please consult the study for the relevant financial information of all other authors.
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