The Effect of Metformin and Intensive Lifestyle Intervention on the Metabolic Syndrome: The Diabetes Prevention Program Randomized Trial

Orchard, Trevor J.; Temprosa, Marinella; Goldberg, Ronald; Haffner, Steven M.; Ratner, Robert E.; Marcovina, Santica M.; Fowler, Sarah E.

doi:10.7326/0003-4819-142-8-200504190-00009

Cited by 824 publications

(551 citation statements)

References 21 publications

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“…28 Abdominal obesity and weight gain are documented as independent cardiovascular risk factors, due in part to their association with insulin resistance and sympathetic nervous activation. 29,30 Weight-loss studies with lifestyle modifications involving a low-calorie diet and exercise [31][32][33] as well as bariatric surgery 34,35 provide some evidence that intentional weight loss has long-term benefits on all cause mortality in overweight/obese adults. Therefore, weight loss is recommended as the first-line treatment for obesity.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, weight loss is recommended as the first-line treatment for obesity. Giving some insight into the possible physiological pathways linking increased morbidity and mortality, elevated sympathetic nervous activity, [36][37][38] insulin resistance 31,32 and stimulation of the renin-angiotensin-aldosterone system 39 are ameliorated after weight loss.…”

Section: Discussionmentioning

confidence: 99%

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Different mechanisms in weight loss-induced blood pressure reduction between a calorie-restricted diet and exercise

et al. 2011

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The present study compared the effectiveness of a mild calorie-restricted diet (D) alone, exercise (EX) alone and a combination of D+EX on weight loss-induced blood pressure (BP) reduction over 24 weeks. We focussed especially on the relationship between sympathetic nervous activity, as indicated from measures of plasma norepinephrine (NE), and insulin resistance (homeostasis model of insulin resistance, HOMA-IR). The three groups each comprised 30 obese, hypertensive men. Body mass index (BMI), fat mass, waist-to-hip ratio, BP, plasma NE and HOMA-IR were measured every 2 weeks during the first 4 weeks and subsequently every 4 weeks for the next 20 weeks. All basal parameters were similar among the three groups. At 24 weeks, the combination group with D+EX comprised a significantly higher prevalence of normotensive subjects than the D alone or EX alone group (Po0.05). In the D alone group, plasma NE was decreased significantly at 2 weeks, reductions in BMI, fat mass and BP were observed at 8 weeks, and waist-to-hip ratios and HOMA-IR were decreased at 12 weeks. In comparison, in the EX alone group, significant reductions of fat mass and HOMA-IR were observed at 4 weeks. Plasma NE and HOMA-IR were reduced at 8 weeks while decreases in BP were detected at 12 weeks. In the D+EX group, significant reductions in plasma NE were observed at 2 weeks followed by significant decreases in BMI, fat mass, waist-to-hip ratio, BP levels and HOMA-IR at 4 weeks. The magnitudes of reductions of all parameters were greatest in the D+EX group. These results demonstrate that D+EX exerts a stronger ameliorative effect on weight loss, weight loss-induced BP reduction, normalization of BP, sympathetic activation and insulin resistance compared with D or EX alone. D and EX might, perhaps, exert different mechanisms on weight loss and weight loss-induced BP reduction; however, a combination of caloric restriction and exercise is preferred to control BP levels in obese hypertensive patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Different mechanisms in weight loss-induced blood pressure reduction between a calorie-restricted diet and exercise

et al. 2011

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“…The chart could be used to motivate individuals to follow lifestyle recommendations and to improve compliance. A1C can be lowered with physical activity, weight management and healthy diet and, thus, opens doors for lifestyle recommendations [11] [12]. Prediabetes can also be effectively treated with Metformin which decreases the rate of conversion from prediabetes to diabetes [11].…”

Section: Discussionmentioning

confidence: 99%

Better risk assessment with glycated hemoglobin instead of cholesterol in CVD risk prediction charts

2013

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Traditional risk charts for the prediction of cardiovascular disease (CVD) include cholesterol parameters. We evaluated how models predict fatal CVD when cholesterol is replaced by glucose parameters. We used data from NHANES III, a US survey conducted 1988-1994 (follow-up until 2006); 15,454 participants (1,716 CVD deaths) were included. Based on the ESC SCORE method, we used age, sex, blood pressure, smoking and either of the following: (1) total cholesterol, (2) total-to-HDLcholesterol, (3) glucose, (4) glycated hemoglobin (A1C). Scaled Brier score (BS), Nagelkerke's R(2) (NR) and integrated discrimination improvement (IDI) were used for model comparison. The ranking (best to worst) was: A1C (BS = 11.62 %; NR = 0.0865; IDI = 0.0091), glucose (11.16 %; 0.0734; 0.0067), total-to-HDL-cholesterol (9.97 %; 0.0547; 0.0010), cholesterol (9.75 %; 0.0484; 0, reference). Differences between models with cholesterol and glucose or A1C were statistically significant. This study suggests the use of A1C instead of cholesterol parameters in charts to assess CVD risk. Abstract Traditional risk charts for the prediction of cardiovascular disease (CVD) include cholesterol parameters. We evaluated how models predict fatal CVD when cholesterol is replaced by glucose parameters.We used data from NHANES III, a US survey conducted 1988-1994 (follow-up until 2006); 15,454 participants (1,716 CVD deaths) were included. Based on the ESC SCORE method, we used age, sex, blood pressure, smoking and either of the following: 1) total cholesterol, 2) total-to-HDL-cholesterol, 3) glucose, 4) glycated hemoglobin (A1C). Scaled Brier score (BS), Nagelkerke's R 2 (NR) and integrated discrimination improvement (IDI) were used for model comparison. The ranking (best to worst) was: A1C (BS=11.62%; NR=0.0865; IDI=0.0091), glucose (11.16%; 0.0734; 0.0067), total-to-HDL-cholesterol (9.97%; 0.0547; 0.0010), cholesterol (9.75%; 0.0484; 0, reference). Differences between models with cholesterol and glucose or A1C were statistically significant. This study suggests the use of A1C instead of cholesterol parameters in charts to assess CVD risk.

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“…After 2.8 years, participants assigned to the lifestyle intervention group had shown a greater increase in physical activity and greater weight loss (−5.6 kg) than those on metformin (−2.1 kg) or placebo (−0.1 kg) ( P < 0.001 for both) 63. Compared with placebo, lifestyle intervention and treatment with metformin had reduced the incidence of type 2 diabetes by, respectively, 58% and 31% 63, and had reduced the incidence of metabolic syndrome by 41% and 17% 64. These findings demonstrate that intense lifestyle intervention can be effective in long‐term weight loss, weight maintenance and in risk associated with comorbidities.…”

Section: Lifestyle Modification and Weight Maintenancementioning

confidence: 95%

Weight maintenance: challenges, tools and strategies for primary care physicians

2015

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SummaryObesity is recognized as a chronic disease and one of the major healthcare challenges facing us today. Weight loss can be achieved via lifestyle, pharmacological and surgical interventions, but weight maintenance remains a lifetime challenge for individuals with obesity. Guidelines for the management of obesity have highlighted the role of primary care providers (PCPs). This review examines the long‐term outcomes of clinical trials to identify effective weight maintenance strategies that can be utilized by PCPs. Because of the broad nature of the topic, a structured PubMed search was conducted to identify relevant research articles, peer‐reviewed reviews, guidelines and articles published by regulatory bodies. Trials have demonstrated the benefit of sustained weight loss in managing obesity and its comorbidities. Maintaining 5–10% weight loss for ≥1 year is known to ameliorate many comorbidities. Weight maintenance with lifestyle modification – although challenging – is possible but requires long‐term support to reinforce diet, physical activity and behavioural changes. The addition of pharmacotherapy to lifestyle interventions promotes greater and more sustained weight loss. Clinical evidence and recently approved pharmacotherapy has given PCPs improved strategies to support their patients with maintenance of weight loss. Further studies are needed to assess the translation of these strategies into clinical practice.

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The Effect of Metformin and Intensive Lifestyle Intervention on the Metabolic Syndrome: The Diabetes Prevention Program Randomized Trial

Abstract: 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.

Cited by 824 publications

References 21 publications

Different mechanisms in weight loss-induced blood pressure reduction between a calorie-restricted diet and exercise

Different mechanisms in weight loss-induced blood pressure reduction between a calorie-restricted diet and exercise

Better risk assessment with glycated hemoglobin instead of cholesterol in CVD risk prediction charts

Weight maintenance: challenges, tools and strategies for primary care physicians

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