Metformin is tied to long-term weight loss in pre-DM

  • Apolzan JW & al.
  • Ann Intern Med
  • 23 Apr 2019

  • International Clinical Digest
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Takeaway

  • Among Diabetes Prevention Program (DPP) participants with ≥5% weight loss after 1 year, those originally randomly assigned to metformin had the greatest weight loss in years 6-15.
  • Older age and amount of initial weight loss predicted long-term weight loss (LTWL) maintenance.

Why this matters

  • Weight loss is a key to preventing or delaying type 2 diabetes (T2D).

Study design

  • The DPP was a randomized controlled trial of 3234 participants with prediabetes mellitus (pre-DM), comparing weight loss with metformin, intensive lifestyle intervention (ILS), or placebo.
  • Participants are followed observationally in the DPP Outcomes Study.
  • Funding: NIH.

Key results

  • Number of participants with ≥5% weight loss in year 1:
    • 289 (28.5%) in metformin group,
    • 640 (62.6%) ILS, and
    • 137 (13.4%) placebo.
  • Mean weight losses from baseline across years 6-15:
    • 6.2% (95% CI, 5.2%-7.2%) in metformin group,
    • 3.7% (3.1%-4.4%) ILS, and
    • 2.8% (1.3%-4.4%) placebo.  
  • Mean percentages with LTWL for years 6-15 were:
    • 56.1% (55.1%-57.1%) for metformin,
    • 43.1% (42.1%-44.1%) ILS, and
    • 41.9% (39.9%-43.9%) placebo, respectively.
  • Independent predictors of LTWL included greater first-year weight loss in all groups and older age and continued metformin use in the metformin group.

Limitations

  • Post-hoc analysis.
  • Examination of nonrandomized subsets after year 1.

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