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                    Diabetes
                    Diabetes Prevention Program (DPP)

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                Reports & PlanningDiabetes Prevention Program (DPP)
    The NIDDK-sponsored Diabetes Prevention Program (DPP) and ongoing DPP Outcomes Study (DPPOS) are major studies that changed the way people approach type 2 diabetes prevention worldwide. The DPP showed that people who are at high risk for type 2 diabetes can prevent or delay the disease by losing a modest amount of weight through lifestyle changes (dietary changes and increased physical activity). Taking metformin, a safe and effective generic medicine to treat diabetes, was also found to prevent the disease, though to a lesser degree.
The DPPOS has continued to follow most DPP participants since 2002. To date, the DPPOS has shown that participants who took part in the DPP Lifestyle Change Program or are taking metformin continue to prevent or delay type 2 diabetes for at least 15 years. The DPPOS has also shown that the DPP Lifestyle Change Program is cost effective (costs are justified by the benefits of diabetes prevention, improved health, and fewer health care costs) and metformin is cost-saving (leads to a small savings in health care costs) after 10-years. DPPOS researchers are also continuing to follow other health problems in participants such as cancer, cardiovascular diseases (heart and blood vessel disease), nerve damage, kidney disease, and eye disease. As participants age, researchers are following age-related health problems such as trouble with physical function and difficulties with thinking or memory.
D P P and D P P O S Timeline.  A graphic showing changes from 1996 to present.The  NIDDK built on the success of the DPP by funding additional research to make modified  versions of the DPP  Lifestyle Change Program that are more  cost-effective and more easily available to the tens of millions of Americans  at risk for type 2 diabetes. Several modified group versions of the DPP Lifestyle Change  Program have shown great promise. One version tested in  YMCAs is now widely available in the United States through a partnership with the CDC’s National  Diabetes Prevention Program. Beginning in 2018, Medicare will cover  participation in the CDC’s National Diabetes Prevention Program for those who  are eligible.
Diabetes Prevention Program (DPP)
DPP Goal
The DPP looked at whether the DPP Lifestyle Change Program or taking metformin would delay or prevent type 2 diabetes.
DPP Results
After about 3 years, the DPP showed that participants in the DPP Lifestyle Change Program lowered their chances of developing type 2 diabetes by 58 percent compared with participants who took a placebo (a pill without medicine). The DPP Lifestyle Change Program was effective for all participating racial and ethnic groups and both men and women. The Program worked particularly well for participants ages 60 and older, lowering their chances of developing type 2 diabetes by 71 percent. About 5 percent of participants in the DPP Lifestyle Change Program developed diabetes each year during the study compared with 11 percent of participants who took a placebo.
Participants who took metformin lowered their chances of developing type 2 diabetes by 31 percent compared with participants who took a placebo.  Metformin was effective for all participating racial and ethnic groups and both men and women. Metformin was most effective in women with a history of gestational diabetes, in people between the ages of 25 and 44, and in people with obesity who had a body mass index of 35 or higher.
DPP Study Design
The DPP was a randomized, controlled clinical trial conducted at 27 clinical centers around the United States from 1996 to 2001. The trial enrolled 3,234 participants; 55 percent were Caucasian, and 45 percent were from minority groups at high risk for the disease, including African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander. The trial also recruited other groups at high risk for type 2 diabetes, including people ages 60 and older, women with a history of gestational diabetes, and people with a parent, brother, sister, or child who had type 2 diabetes.
DPP participants were randomly assigned to one of the following groups:
**Lifestyle  Change Group**– Group participants joined a DPP Lifestyle Change Program that provided intensive  training. Participants tried to lose 7 percent of their body weight and  maintain that weight loss by eating less fat and fewer calories and exercising  150 minutes per week. Researchers met with participants individually at least  16 times in the first 24 weeks, and then every 2 months with at least 1 phone  call between visits.
    **Metformin  Group**– Group participants took 850 mg of metformin twice a day and were  provided standard advice about diet and physical activity.
    **Placebo  Group**– Group participants took a placebo twice a day instead of metformin and were  provided standard advice about diet and physical activity.DPP participants who developed diabetes remained in the study and received additional care from their own physicians if good blood glucose control could not be maintained.
After DPP ended all participants were provided a modified group version of the DPP’s Lifestyle Change program.
Diabetes Prevention Program Outcomes Study (DPPOS)
DPPOS Goal
The DPPOS is following DPP participants to see if participants who took part in the DPP Lifestyle Change Program or who are continuing to take metformin have a delay in the development of type 2 diabetes over time and if they experience fewer health problems such as cancer, cardiovascular diseases, nerve damage, kidney disease, eye disease, and age-related health problems such as trouble with physical function and difficulties with thinking or memory.
DPPOS Results
10-Year Findings
At the 10-year follow-up
participants who took part in the DPP  Lifestyle Change Program continued to have a delay in the development of diabetes  by 34 percent—and developed  diabetes about 4 years later—compared  with participants who took a placebo. Participants from the DPP  Lifestyle Change Program ages 60 and older had a delay in the development of  diabetes by 49 percent.
    participants who continued to take metformin had a delay in the  development of diabetes by 18 percent—and  developed diabetes about 2 years later—compared  with participants who took a placebo.
    participants from the DPP Lifestyle Change Program and  participants who continued to take metformin or took a placebo all improved  their risk factors for cardiovascular diseases, such as high blood pressure and  cholesterol. However, the participants from the DPP Lifestyle Change Program achieved  these results with fewer blood pressure and cholesterol-lowering medications.
    the DPP Lifestyle Change Program was shown to be  cost-effective and metformin was shown to be cost-saving.15-Year Findings
At the 15-year follow-up
participants from the DPP Lifestyle Change Program continued  to have a delay in the development of diabetes by 27 percent compared with  participants who took a placebo.
    participants who continued to take metformin had a delay in  the development of diabetes by 18 percent compared with participants who took a  placebo.
    about half (55 percent) of participants from the DPP  Lifestyle Change Program and 56 percent of participants who continued to take metformin  developed diabetes compared with 62 percent of participants who took a placebo.
    there were no overall differences in small blood vessel  problems such as those found in eyes, nerves, and kidneys between participants  from the DPP Lifestyle Change Program and  participants who continued to take metformin or took a placebo. However, women from  the DPP Lifestyle Change Program developed fewer small blood vessel problems  than participants who continued to take metformin or took a placebo. Participants  who did not develop diabetes had a 28 percent lower rate of small blood vessel  problems compared with participants who developed diabetes.Current Focus
In early 2016 the NIDDK, in partnership with the National Heart Lung and Blood Institute (NHLBI) and National Cancer Institute (NCI), began funding a third phase of DPPOS—proposed to last 10 years—to find out if people who are at high risk for type 2 diabetes and take metformin have lower rates of cardiovascular diseases and cancer, as suggested by several earlier small-scale studies.
DPPOS Study Design
The DPPOS follow-up study started in 2002. All 3,149 surviving participants of DPP groups were eligible for the DPPOS, including those with and without diabetes. Of the 3,149 surviving participants, 2,776 (88 percent) joined the DPPOS. Similar proportions of each DPP group joined the DPPOS and remained in their original groups.  There were some changes to the treatments each group received:
**Lifestyle  Change Group** –Group participants  received quarterly group lifestyle change classes throughout the study and two  group classes yearly to reinforce self-management behaviors for weight loss.
    **Metformin  Group**– Group participants received quarterly group lifestyle  change classes throughout the study. Participants continued to take metformin  and were told that they were taking metformin.
    **Placebo  Group** – Group participants received quarterly group lifestyle  change classes throughout the study. Participants did not take a placebo pill.DPPOS participants who developed diabetes remained in the study and received additional care from their own physicians if good blood glucose control could not be maintained.
Related Health Information
**CDC’s National Diabetes Prevention Program** – The  CDC’s National Diabetes Prevention Program uses key components of the  DPP—lifestyle changes such as physical activity and weight loss—to prevent or  delay the start of type 2 diabetes.
    **Health Information on Diabetes** –  The NIDDK offers information on many diabetes-related topics.Related Studies
**Scalable  modified versions of the DPP****Lifestyle Change Program**–  Researchers are making modified group versions of the DPP Lifestyle Change  Program—such as the YMCA’s Diabetes Prevention Program—that  are more cost-effective and more easily available to Americans at risk for type  2 diabetes.
    **Action for Health in Diabetes  (Look AHEAD) Study** – Look  AHEAD used an intensive lifestyle change program modeled on the DPP Lifestyle  Change Program to study how diet and physical activity affect heart attack,  stroke, and cardiovascular disease-related death in people who already had type  2 diabetes.
    **Vitamin D and Type 2 Diabetes  (D2d)** – This ongoing study is examining whether vitamin D supplements  can reduce or delay development of type 2 diabetes in people at high risk for  the disease.
    **Studies on lifestyle change** – Researchers are looking at cost-effective  ways to teach people about lifestyle change and weight loss, such as in group  settings and over the internet.
    **Ancillary  studies of DPP and DPPOS data** – Researchers  continue to study DPP and DPPOS data. One study found that DPP participants  carrying two copies of a gene mutation were at a higher risk of developing  diabetes but benefited from lifestyle changes as much as, or more than, those  without the gene mutation. Another study found that weight loss was the main way  to predict whether a participant in the DPP Lifestyle Change Program would have  a lower risk of developing diabetes. Researchers said that risk-reduction  efforts should focus on weight loss, which is helped by increased physical  activity.News Releases and Reports
Diabetes  Prevention Program Outcomes Study launches new phase to study CVD, cancer  outcomes
    Diabetes  Prevention Program Outcomes Study commemorates 20 years of landmark research
    NIH  study finds interventions to prevent type 2 diabetes provide good return on investmentScientific Publications and Resources
DPPOS  website
    DPP on  ClinicalTrials.gov
    DPPOS  on ClinicalTrials.gov
    DPP documents  and materials from the NIDDK Central Repository
    DPPOS documents  and materials from the NIDDK Central Repository
    DPP  grant award information from dkNET
    DPPOS  grant award information from dkNET
    Type  2 Diabetes Knowledge Portal
    Diabetes  Prevention Program (DPP) Research Group. The  Diabetes Prevention Program (DPP): description of lifestyle intervention. *Diabetes Care* 2002;25(12):2165‒2171.
    Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in  the incidence of type 2 diabetes with lifestyle intervention or metformin. *The New England Journal of Medicine*.  2002;346(6):393–403.
    Diabetes  Prevention Program Research Group, Knowler WC, Fowler SE, et al. 10-year follow-up of diabetes incidence and weight loss in  the Diabetes Prevention Program Outcomes Study. *Lancet.*2009;374(9702):1677–1686.
    Diabetes  Prevention Program Research Group. The 10-year cost-effectiveness of lifestyle intervention or metformin  for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS. *Diabetes Care* 2012; 35(4):723–730.
    Diabetes Prevention Program Research Group,  Orchard TJ, Temprosa M, et al. Long-term  effects of the Diabetes Prevention Program interventions on cardiovascular risk  factors: a report from the DPP Outcomes Study. *Diabetic Medicine.*2013;30(1):46–55.
    Diabetes  Prevention Program Research Group. Long-term effects of lifestyle  intervention or metformin on diabetes development and microvascular complications  over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. *The Lancet Diabetes &  Endocrinology* 2015;3(11):866–875.
        Last Reviewed May 2023 Contact Us
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