A large multicenter clinical trial designed to determine whether weight loss from dietary changes and exercise or the oral diabetes drug metformin could prevent or delay the onset of Type 2 diabetes in participants with a condition called prediabetes. The Diabetes Prevention Program (DPP) showed that modest weight loss through dietary changes and exercise dramatically decreased the risk of those with prediabetes developing Type 2 diabetes. Taking metformin decreased the risk to a significantly lesser extent.
Prediabetes is characterized by blood glucose levels that are higher than normal but not high enough to qualify for a diagnosis of diabetes. It is estimated that 35% of adults in the United States – or 79 million people – had prediabetes in 2010. Having prediabetes puts a person at risk of developing Type 2 diabetes, as well as cardiovascular disease.
In the DPP, participants from 27 clinical centers around the United States were randomly assigned to one of four groups: The first group, the lifestyle intervention group, received intensive training in diet, physical activity, and behavior modification with the goal of losing weight. The second group received 850 milligrams (mg) of metformin twice a day. The third group received placebos (inactive pills) instead of metformin. A fourth group received the diabetes drug troglitazone (brand name Rezulin), but this arm of the study was discontinued after researchers discovered that troglitazone can cause serious liver damage. (The drug was subsequently taken off the market.)
The lifestyle intervention group reduced their risk of developing diabetes by 58%, while those taking metformin reduced their risk by 31%.
In the interest of having as many Americans as possible benefit from these research findings, the Centers for Disease Control and Prevention (CDC) received funding from Congress to create the National Diabetes Prevention Program (NDPP). A primary goal of the NDPP is to establish a nationwide network of community-based lifestyle intervention programs for people at high risk of developing Type 2 diabetes. An initial trial program based on the methods used in the DPP was carried out at the YMCA of Greater Indianapolis and was found to replicate the successful results of the original study.
Since then the YMCA of the USA, in partnership with the CDC and UnitedHealth Group (a for-profit provider of health insurance and other services), has launched a series of programs in major metropolitan areas based on the original DPP’s lifestyle intervention. The program, called YDPP, starts with a 16-session class in which trained coaches help groups of 8–15 participants increase their physical activity, eat more healthfully, and make other positive lifestyle changes. Following the initial 16 sessions, participants meet monthly for added support to help them maintain their progress.
In late March 2011, the YMCA of Greater New York announced the expansion of the program in New York City to make it available to all New Yorkers who qualify. (Currently, approximately 1.4 million adult New Yorkers have prediabetes.) The program is offered at a low cost for anyone who wishes to participate, and financial assistance is also available through the YMCA Strong Kids Campaign. In addition, the YMCA of Greater New York has pledged that no one with a referral from a health-care professional will be turned away from the program.
YMCAs in many smaller cities are also rolling out new or expanded YDPP programs in 2011. To find out if your community YMCA has or plans to start a diabetes prevention program as part of the NDPP effort, give them a call. Class fees vary by locality.