Lifestyle Changes Yielded Slightly Lower Multimorbidity Rates Than Metformin After 21 Years

A 21-year follow-up of adults at high risk for diabetes showed that intensive lifestyle changes produced lower rates of multiple chronic conditions than either metformin or placebo. The Diabetes Prevention Program enrolled 3,234 adults starting in 1996.

Participants were randomly assigned to intensive lifestyle intervention, metformin, or placebo for three years, then entered long-term follow-up that continued through 2021.

Researchers tracked 1,173 participants who later enrolled in Medicare. After 21 years, 82 percent of those in the lifestyle group developed multimorbidity, compared with 85 percent in the metformin group and 87 percent in the placebo group. The lifestyle intervention required a low-fat, low-calorie diet and at least 150 minutes of physical activity each week.

The study examined 15 common chronic conditions drawn from Medicare claims data, including hypertension, cancer, dementia, Alzheimer’s disease, chronic kidney disease, heart failure, osteoporosis, and stroke. Multimorbidity was defined as two or more of these conditions occurring at the same time.

Metformin, a decades-old medication used to treat Type 2 diabetes, performed no better than placebo in reducing the long-term burden of multiple illnesses.

Dr. Shirin Jaggi, an endocrinologist at Northwell Health who was not involved in the study, described the findings as powerful because they allow physicians to tell patients that changes beyond medication can be more effective. com that lifestyle adjustments must be introduced gradually.

“We have to start slow and work our way up to it,” Dr. Jaggi said. ” She added that frequent check-ins help determine whether goals are being met and that the approach can differ for each patient. “For me to be able to tell patients that there is something they can do beyond prescription, which could be even more powerful than a prescription, I think it’s amazing,” Dr.