This observational follow-up of the Diabetes Prevention Program (DPP) and DPP Outcomes Study (DPPOS) examined whether intensive lifestyle intervention or metformin (vs. placebo) reduced long-term multimorbidity (≥2 of 15 chronic conditions) in 1,173 adults with prediabetes, followed from 1996 to 2021 using CMS claims data.
Lifestyle intervention was associated with a 21% lower risk of multimorbidity vs. placebo (HR 0.79; 95% CI 0.68–0.93); for the costliest condition dyads, the reduction was 43% (HR 0.57; 95% CI 0.38–0.85). Metformin showed no significant benefit vs. placebo (HR 0.91; 95% CI 0.78–1.07). Overall, 85% of participants developed ≥2 conditions (82% lifestyle, 85% metformin, 87% placebo).
- Only 1,173 of 3,234 original DPP participants had CMS data available (consent-based subset), raising selection bias concerns. - Observational follow-up design after the RCT phase limits causal inference, especially given unmasking and protocol changes in DPPOS. - Multimorbidity defined using administrative claims (CMS Chronic Condition Data Warehouse), which may miss or misclassify conditions.
Intensive lifestyle intervention in adults with prediabetes is associated with meaningful, long-term reductions in multimorbidity burden — effects that persist decades later. Clinicians should prioritize structured lifestyle programs for prediabetic patients as a strategy to delay not just diabetes, but multiple chronic diseases.
Explore related topics
