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Results of the Diabetes Prevention Program (DPP): What does this mean to ITUs?

Results of the Diabetes Prevention Program (DPP): What does this mean to ITUs?. Kelly Acton, MD, MPH, FACP Director, National Diabetes Program http://www.ihs.gov/medicalprograms/diabetes. Prevalence of diagnosed diabetes among children and young AI/AN by age group, 1990-1998. Per 1000.

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Results of the Diabetes Prevention Program (DPP): What does this mean to ITUs?

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  1. Results of the Diabetes Prevention Program (DPP):What does this mean to ITUs? Kelly Acton, MD, MPH, FACP Director, National Diabetes Program http://www.ihs.gov/medicalprograms/diabetes

  2. Prevalence of diagnosed diabetes among children and young AI/AN by age group, 1990-1998 Per 1000 50% increase 47% increase 68% increase 6% increase Year Source: IHS Diabetes Program Statistics

  3. The Diabetes Prevention Program (DPP) • Major clinical trial funded by NIH • 27 centers (including an American Indian center comprised of Zuni, Shiprock, Gila River, Salt River & Phoenix Indian Medical Center) • Compared diet & exercise to the medication metformin

  4. Diabetes Prevention Program Sites

  5. The Diabetes Prevention Program (DPP) • 3,234 overweight participants with impaired glucose tolerance (IGT) • Average age 51 yrs (range: 25-85 yrs) • 45% from ethnic/minority groups (171 American Indian participants, 5% of the study)

  6. Stages in the natural history of Type 2 diabetes Disability Death Normal IGT Type 2 DM Complications Genetic predisposition Preclinical state Clinical disease Disability Death Complications Primary Secondary Tertiary prevention prevention prevention

  7. DPP Goals: Primary • To prevent or slow the development of type 2 diabetes in persons with impaired glucose tolerance (IGT) and other high risk characteristics

  8. DPP Goals: Secondary • Reduce cardiovascular disease (CVD) risk factors and CVD events • Regulate weight gain in participants • Prevent or delay the development of diabetes complications

  9. Obesity Body fat distribution Family history of diabetes Physical inactivity Race/ethnicity Age Previous gestational diabetes (GDM) Elevated fasting glucose Impaired glucose tolerance Screening for Type 2 Diabetes: Risk Factors

  10. Impaired Glucose Tolerance (IGT) • Risk factor for type 2 diabetes • Increases risk of type 2 diabetes 5 - 8 fold • 1-5% per year develop type 2 diabetes • Risk factor for cardiovascular disease (CVD) • IGT may be optimal time for intervention • Asymptomatic • Few, if any complications present • Potentially reversible

  11. DPP Study Population Eligibility Criteria • Individuals with IGT • Fasting glucose 95-125 mg/dL • [Native Americans 125 mg/dL] • and Two hour glucose 140-199 mg/dL • Body mass index >24 kg/m2(Asians > 22 kg/m2 ) • Age > 25 years • Men and Women • All ethnic groups • goal of 50% from high risk populations

  12. Study interventions Eligible participants Randomized Standard lifestyle recommendations Metformin (n = 1073) Placebo (n = 1082) Intensive Lifestyle (n = 1079)

  13. Lifestyle Intervention Intensive Lifestyle Modification A comprehensive program with the following specific aims: • Reduction of fat and calorie intake • Physical activity at least 150 minutes / wk • > 7% loss of body weight

  14. Metformin • A medication approved for use in type 2 diabetes • Mechanism of action (how it works) • Lowers glucose (sugar) production by the liver • Increases glucose uptake and use by the muscles and organs • Decreases glucose uptake by the gut • Does not stimulate insulin production

  15. Primary Outcomes • Annual FPG and 75 gm OGTT • Test for onset of diabetes (FPG > 126 mg/dL or 2-hr > 200 mg/dL, confirmed with repeat OGTT) • Semi-annual FPG • > 126 mg/dL confirmed

  16. DPP Study Results • Participants from the lifestyle group reduced their risk of getting type 2 diabetes by 58% • Participants from the metformin group reduced their risk of getting type 2 diabetes by 31%

  17. DPP Study Results • Lifestyle intervention worked very well in elderly (>60 yrs), reducing development of diabetes by 71% • Metformin was not effective in older participants or in less overweight

  18. What do the results of the DPP mean to ITUs?

  19. What do the results of the DPP mean to ITUs? • Screening for diabetes AND for IGT in AI/AN communities • Create lifestyle programs for diabetes prevention • Purchase metformin for diabetes prevention

  20. Short-term Plans for Use of the DPP Results • Interview American Indian participants of the DPP • Press releases in the Indian press • Feature DPP at the national TLDC diabetes conference • Special edition of the Health for Native Life magazine

  21. Long-term Plans for Use of the DPP Results • Define screening criteria & issues • Use experience from grant programs & others to develop lifestyle programs • Advocate to Congress for additional funds to purchase metformin and lifestyle program equipment & training

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