New Diabetes Prevention Program Data Indicates Physical Activity Helps Prevent Type 2 Diabetes, Independent of Weight Loss

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Jun 14, 2016, 12:45 ET

NEW ORLEANS, June 14, 2016 /PRNewswire-USNewswire/ -- Physical activity, independent of weight loss, may help to prevent or delay type 2 diabetes in people who are at high risk for diabetes, according to new follow-up data from the landmark Diabetes Prevention Program (DPP) study, presented today in the President's Oral Session at the American Diabetes Association's 76th Scientific Sessions^® at the Ernest N. Morial Convention Center in New Orleans.

The DPP¹ was primarily supported by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of National Institutes of Health. Published in 2002, the study found that lifestyle changes, including moderate weight loss and increased physical activity, reduced the chance of developing type 2 diabetes by 58 percent over three years in overweight people with prediabetes. Study participants were randomized to one of three groups: lifestyle intervention, metformin or placebo. Both lifestyle and metformin substantially reduced the risk of developing type 2 diabetes, with the lifestyle intervention more effective than metformin. Participants in the lifestyle intervention arm of this multi-center study received an intensive behavioral intervention composed of nutrition and physical activity with the two goals of being physically active for a minimum of 150 minutes per week, and achieving a weight loss of 7 percent.

Due to the success of the lifestyle intervention, all participants were provided a modified version of the intervention and asked to participate in the DPP Outcomes Study (DPPOS), also supported by NIDDK. Despite the fact that everyone beginning the DPPOs had been offered the lifestyle intervention, the DPPOS demonstrated that the lifestyle arm maintained a significantly lower cumulative diabetes incidence than the other two groups, which could not be explained by differences in weight loss.

The current study is a 12-year follow-up of the subgroup of 1,793 participants (93% of eligible cohort; n for lifestyle = 589; metformin =599; and placebo =605) who were part of a DPP ancillary study in which they were asked to wear an activity monitor for one week. The interviewer-administered Modifiable Activity Questionnaire was used to track physical activity (PA) yearly, and diabetes status was determined by annual oral glucose tolerance and semi-annual fasting plasma glucose tests.

The researchers found that in all three treatment groups, diabetes incidence was lower for participants who were more physically active, regardless of changes in weight. Specifically, there was a 2 percent decrease in diabetes incidence (HR 0.98 [0.97, 0.99]; P<0.0001) for each 6 MET-hours/week increase (roughly 1.5 more hours/week of activity equivalent to a brisk walk). Cumulative physical activity levels were highest in the lifestyle intervention group (P=0.003, in a mixed model of PA over the entire study), and the incidence of type 2 diabetes was lowest in the lifestyle intervention arm. The reduction in type 2 diabetes risk was greatest for participants who were least active at baseline (reporting fewer than 150 minutes of physical activity per week) compared to those who met the 150-minutes per week goal (5% decrease, n=728; HR 0.95 [0.93, 0.97]; P<0.0001).

"These current results show that physical activity, over an average of 12 years, decreased the chances of developing diabetes even after considering any changes in weight. This protective effect was greater in those who were less active at baseline. They also suggest that the lower development of diabetes across the entire study in those that took part in the lifestyle arm of the study may be partially explained by improvement in physical activity levels as well as weight loss," said one of the lead investigators, Andrea M. Kriska, PhD, MS, Professor, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health.

"Until now, the importance of physical activity in preventing diabetes development in the DPP was thought to be due to its role in achieving weight loss and weight maintenance; however, it was not considered a strong key factor alone," Kriska continued. "It is important for health care professionals to look beyond their high-risk patients' weight, and also consider their physical activity levels, when discussing strategies to prevent progression to type 2 diabetes."

The American Diabetes Association's 76th Scientific Sessions, to be held June 10-14, 2016, at the Ernest N. Morial Convention Center in New Orleans, is the world's largest scientific meeting focused on diabetes. The 2016 Scientific Sessions is expected to attract more than 16,000 attendees and offers researchers and health care professionals from around the world the opportunity to share ideas and learn about the significant advances in diabetes research, treatment and care. During the five-day meeting, attendees receive exclusive access to more than 2,500 original research presentations, participate in provocative and engaging exchanges with leading diabetes experts, and can earn Continuing Medical Education (CME) or Continuing Education (CE) credits for educational sessions. The program is grouped into eight theme areas: Acute and Chronic Complications; Behavioral Medicine, Clinical Nutrition, Education and Exercise; Clinical Diabetes/Therapeutics; Epidemiology/Genetics; Immunology/Transplantation; Insulin Action/Molecular Metabolism; Integrated Physiology/Obesity; and Islet Biology/Insulin Secretion. Margaret A. Powers, PhD, RD, CDE, President, Health Care & Education, will deliver her address on Saturday, June 11, and Desmond Schatz, MD, President, Medicine & Science, will present his address on Sunday, June 12. The top eight abstracts of this year's Scientific Sessions will be presented on Tuesday, June 14, in the Presidents Oral Session. In total, the 2016 Scientific Sessions includes 378 abstracts in 50 oral sessions, 2,021 poster presentations including 59 moderated poster discussions, and 335 published-only abstracts. The Association's 2016 Scientific Achievement Awards and Lectures are:

Barbara B. Kahn, MD, Banting Medal for Scientific Achievement, the Association's highest honor. Kahn will deliver the Banting Medal Lecture, "Adipose Tissue, Inter-organ Communication, and the Path to T2D," on Sunday, June 12.
Tamas L. Horvath, DVM, PhD, Outstanding Scientific Achievement Award (OSAA), will present his OSAA Lecture, "Hunger-promoting Hypothalamic Neurons Control System Metabolism and Drive Complex Behaviors and Longevity," on Monday, June 13.
Sheri R. Colberg-Ochs, PhD, FACSM, Outstanding Diabetes Educator, will present her Lecture, "From Froot Loops^® to Fitness—My Journey as an Educator and PWD," on Saturday, June 11.
Edward W. Gregg, PhD, Kelly West Award for Outstanding Achievement in Epidemiology, will deliver his Lecture, "The Changing Tides of the Diabetes Epidemic—Smooth Sailing or Troubled Waters Ahead?," on Sunday, June 12.

Additional scientific research will be presented during 110 Symposia and nine Professional Interest Group sessions. The 76th Scientific Sessions also includes presence from more than 130 corporate and organizational exhibitors in nearly 100,000 square feet of exhibit space. Join the Scientific Sessions conversation on Twitter, #2016ADA.

About the American Diabetes Association
The American Diabetes Association is leading the fight to Stop Diabetes^® and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, the Association's mission is to prevent and cure diabetes, and to improve the lives of all people affected by diabetes. For more information, please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit diabetes.org. Information from both of these sources is available in English and Spanish. Find us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).

76th Scientific Sessions
News Briefing: Diabetes Prevention and Improved Management, Monday, June 13, 2016, 10:30 a.m. CT

ADA Presidents Oral Session
Oral Presentation: Great Hall B
Session Time: Tuesday, June 14, 2016, 10:15 a.m. – 12:15 p.m.

379-OR
Physical Activity and Diabetes Development: The Diabetes Prevention Program (DPP) Outcomes Study

ANDREA M. KRISKA, BONNY ROCKETTE-WAGNER, SHARON L. EDELSTEIN, ELIZABETH M. VENDITTI, GEORGE A. BRAY, LINDA M. DELAHANTY, EDWARD S. HORTON, MARY A. HOSKIN, WILLIAM C. KNOWLER, DPP RESEARCH GROUP, Pittsburgh, PA, Rockville, MD, Baton Rouge, LA, Boston, MA, Phoenix, AZ

After more than ten years of DPP follow-up, cumulative diabetes incidence remained lower in the lifestyle compared to placebo and metformin groups, and this could not be completely explained by weight change. Since physical activity (PA) was ascertained annually by the past-year Modifiable Activity Questionnaire and diabetes was determined annually by OGTT and semi-annually by fasting plasma glucose, we were able to examine whether PA contributed to the lower cumulative diabetes incidence observed in the lifestyle group.

All analyses were carried out in a subgroup of 1,796 participants who were also part of a DPP ancillary study. Cumulative PA was significantly higher in the lifestyle than in the metformin and placebo groups (P=0.003, in a mixed model of PA over the entire study).The association between time-dependent PA and diabetes incidence was examined using Cox proportional hazards models controlled for age, sex, baseline PA, and baseline and time-dependent weight. Regardless of treatment group, over an average 11.9 years, there was a 2% (HR 0.98 [0.97, 0.99]; P<0.0001) decrease in diabetes incidence for each 6 MET-hrs/week increase in PA (equivalent to 1.5 more hours/week of a brisk walk). The protective effect of increasing PA was greater in participants reporting <150 minutes/week at baseline (5% decrease, n=728; HR 0.95 [0.93, 0.97]; P<0.0001) relative to those who already met that goal at baseline or if the analysis was limited to the lifestyle group alone.

In summary, although the DPP study was not designed to examine the separate effects of PA (or weight) on diabetes incidence, post-hoc analyses indicate that PA levels over the entire DPP and its Outcomes Study were inversely related to incident diabetes when controlled for weight and other important covariates. These results suggest that the lower cumulative diabetes incidence found in the lifestyle group across the entire study was partially explained by PA differences.

Author Disclosure Block:
A.M. Kriska: None. B. Rockette-Wagner: None. S.L. Edelstein: None. E.M. Venditti: Board Member; Author; Aastrom Biosciences, Inc.. Research Support; Author; National Institute of Diabetes and Digestive and Kidney Diseases. G.A. Bray: None. L.M. Delahanty: Advisory Panel; Author; Eli Lilly and Company, Nutrisystem, Janssen Pharmaceuticals, Inc., Omada Health, Inc.. Consultant; Author; JanaCare. E.S. Horton: Advisory Panel; Author; Amgen Inc., AstraZeneca, Sanofi U.S., Theracos, Inc., Takeda Development Center Americas, Inc., PTS Diagnostics. Consultant; Author; Axon Advisors. Speaker's Bureau; Author; Merck & Co., Inc, Platform Q Health. M.A. Hoskin: None. W.C. Knowler: None.

¹ Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The Diabetes Prevention Program Research Group. N Engl J Med 2002;346 (6):393-403.

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SOURCE American Diabetes Association