D and PA+D  interventions had larger effects on glucose reduction  than PA alone .
Lifestyle  interventions significantly improved FPG , HbA1c , FI , HOMA-IR , and bodyweight among adults without IGT or diabetes , and might reduce progression of hyperglycemia to type 2 diabetes mellitus
This study systematic ally assessed the effectiveness of lifestyle interventions on glycemic indicators among adults ( ⩾18years ) without IGT or diabetes .
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin
D and PA+D  interventions had larger effects on glucose reduction  than PA alone .
Lifestyle  interventions significantly improved FPG , HbA1c , FI , HOMA-IR , and bodyweight among adults without IGT or diabetes , and might reduce progression of hyperglycemia to type 2 diabetes mellitus
This study systematic ally assessed the effectiveness of lifestyle interventions on glycemic indicators among adults ( ⩾18years ) without IGT or diabetes .