Pre-Diabetes: Early Weight Loss Reduces Longer-Term Diabetes Risk Interview with: Nisa M. Maruthur, MD, MHS
Assistant Professor of Medicine & Epidemiology
The Johns Hopkins University

Early Response to Preventive Strategies in the Diabetes Prevention Program What are the main findings of the study?

Dr. Maruther: For patients engaged in a lifestyle intervention to prevent diabetes, weight loss early on (at 6 months) is an extremely strong predictor of whether they will develop diabetes down the road.  Even in the setting of substantial weight loss (>10%) at 6 months, it is still beneficial to lower fasting glucose.  These results are unique in that we previously understood that weight loss over time (years) is important to prevent diabetes, but now we know the impact of early weight loss on longer-term diabetes risk. Were any of the findings unexpected?

Dr. Maruther: None were exactly unexpected, but we did find that fasting glucose is much more helpful than weight for following response to metformin. What should clinicians and patients take away from your report?

Dr. Maruther: substantially reduce their risk of diabetes.  A patient who is obese and loses weight but remains in the obese category is still expected to experience the benefits of weight for diabetes risk reduction.

Physicians can use our study to quantify the impact of their patients’ weight loss at 6 months on their longer-term risk of diabetes.  For example, patients who are undergoing lifestyle change and lose 7-10% of their initial body weight by 6 months have a 66% relative risk reduction for diabetes on average.

Physicians can also use our results to determine if they should intensify preventive therapy.  Currently, clinicians employ lifestyle change as the main intervention to prevent diabetes in their patients.  Our study endorses that approach but also shows that for those who do not lose much weight, lowering fasting glucose is still beneficial to decrease risk of diabetes.  Metformin could be used for that. What recommendations do you have for future research as a result of this study?

Dr. Maruther:  We need to conduct studies to evaluate the strategy of intensifying therapy (e.g., adding metformin) based on 6-month weight and fasting glucose.  We could ultimately individualize care for patients with pre-diabetes by tailoring intervention strategies to patients’ individual responses.  Our study provides data to inform the design of such studies.



Early Response to Preventive Strategies in the Diabetes Prevention Program
Nisa M. Maruthur MD, MHS,   Yong Ma PhD,   Linda M. Delahanty MS, RD,  Julie A. Nelson RD,   Vanita Aroda MD,   Neil H. White MD, CDE,   David Marrero PhD,  Frederick L. Brancati MD, MHS,  Jeanne M. Clark MD, MPH Journal of General Internal Medicine July 2013



Last Updated on April 19, 2014 by Marie Benz MD FAAD