The metabolic syndrome affected approximately half of the participants in the Diabetes Prevention Program at baseline. Both lifestyle intervention and metformin therapy reduced the development of the syndrome in the remaining participants.

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The prevalence of and interrelationships among all four major complications of insulin-dependent diabetes mellitus (IDDM) and their risk factors are being examined in a large epidemiologic study of IDDM subjects diagnosed in childhood. This article focuses on the baseline prevalence of complications in the 657 subjects diagnosed between 1950 and 1980 and currently aged 8-48 yr, with a mean duration of 20 yr. In addition to background retinopathy being virtually universal after 20 yr of diabetes, proliferative retinopathy affects 70% of IDDM subjects after 30 yr duration. As with overt nephropathy, prevalence of proliferative retinopathy is marginally higher in females than in males at short durations; the previously reported male excess is limited to the subjects with IDDM of longer duration (greater than or equal to 25 yr). Somewhat different patterns of microalbuminuria are also seen by sex. Males show a threefold increase in prevalence from 10 to 25 yr duration, whereas females show a more constant prevalence across these durations. A further rise in microalbuminuria is seen in males but not females at greater than or equal to 30 yr duration, giving a combined prevalence of microalbuminuria and overt nephropathy at greater than or equal to 30 yr duration of 84% (males) and 59% (females). Distal symmetrical polyneuropathy shows a constant rise with duration and is only marginally higher in men. Prevalence of cardiovascular (coronary and cerebral) disease shows no sex difference, whereas peripheral vascular disease is particularly common in women after 30 yr duration (greater than 30%) compared with men (11%) when determined by ankle/arm blood pressure ratio less than 0.8 at rest or after exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

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Candesartan, 32 mg/d, for 4.7 years did not prevent microalbuminuria in mainly normotensive patients with type 1 or type 2 diabetes.

OBJECTIVE -Diabetes is associated with increased urinary incontinence risk. Weight loss improves incontinence, but exercise may worsen this condition. We examined whether an intensive lifestyle intervention or metformin therapy among overweight pre-diabetic women was associated with a lower prevalence of incontinence.RESEARCH DESIGN AND METHODS -We analyzed data from the Diabetes Prevention Program, a randomized controlled trial in 27 U.S. centers. Of the 1,957 women included in this analysis, 660 (34%) were randomized to intensive lifestyle therapy, 636 (32%) to metformin, and 661 (34%) to placebo with standard lifestyle advice. The main outcome measure was incontinence symptoms by frequency and type by a validated questionnaire completed at the end-of-trial visit (mean 2.9 years).RESULTS -The prevalence of total (stress or urge) weekly incontinence was lower among women in the intensive lifestyle group (38.3%) than those randomized to metformin (48.1%) or placebo (45.7%). This difference was most apparent among women with stress incontinence (31.3% for intensive lifestyle group vs. 39.7% for metformin vs. 36.7% for placebo, P ϭ 0.006). Changes in weight accounted for most of the protective effect of the intensive lifestyle intervention on stress incontinence.CONCLUSIONS -Less-frequent urinary incontinence may be a powerful motivator for women to choose lifestyle modification to prevent diabetes. Diabetes Care 29:385-390, 2006T ype 2 diabetes and urinary incontinence are chronic, common, and costly disorders. While ϳ18 million adults in the U.S. have diabetes, estimates of adults with pre-diabetes, defined as impaired glucose tolerance and/or impaired fasting glucose (1,2), range from 17 to 43 million. Recently, large randomized controlled trials have shown that diabetes can be prevented by intensive lifestyle intervention in this high-risk pre-diabetic group (3,4) Urinary incontinence, present in nearly 50% of middle-aged and older women, results in psychological stress and social isolation and has a profound effect on quality of life (5,6). The costs of incontinence are substantial, accounting for up to $32 billion per year in the U.S., greater than the annual direct costs for breast, ovarian, cervical, and uterine cancers combined (7,8).Type 2 diabetes is associated with a 50 -70% increased risk of incontinence in women (5,9,10). There have been no studies to determine whether nondiabetic women with abnormal glucose levels (pre-diabetes) are at increased risk for incontinence. Weight reduction and increased physical activity in individuals with pre-diabetes decreases the risk of type 2 diabetes (3,4). Weight reduction in obese women with incontinence has been shown to significantly decrease incontinence in small prospective studies (11-13). However, some studies have reported that increased physical activity worsens incontinence and that incontinence may be a barrier to exercise (14,15).We therefore examined data from 1,987 overweight women at high risk for diabetes who were enrolled in the Diabetes Preventi...

Increases in subclinical inflammation (C-reactive protein [CRP]) and impaired coagulation have been associated with increased obesity and insulin resistance. Only a few small studies have examined the effect of lifestyle changes, such as weight loss, increased physical activity, and insulin-sensitizing intervention on inflammation and coagulation. The Diabetes Prevention Program (DPP) clinical trial studied the effect of an intensive lifestyle intervention or metformin on progression to diabetes relative to placebo in 3,234 adults with impaired glucose tolerance. The effects of these interventions on CRP and fibrinogen at 12 months are examined in this report. Metformin reduced CRP in women compared with the placebo group. In men, the median changes in CRP from baseline to 1 year were -33% in the lifestyle group, -7% in the metformin group, and +5% in the placebo group. In women, the changes in CRP from baseline to follow-up were -29% in the lifestyle group, -14% in the metformin group, and 0% in the placebo group. In the lifestyle group weight loss rather than increased physical activity seems to account for most of the changes in CRP. Only modest reductions (although significant) were seen in fibrinogen levels in the lifestyle group relative to the metformin and placebo group. Lifestyle intervention reduced levels of nontraditional cardiovascular risk factors relative to both placebo and to a lesser degree to metformin.