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Randomized Controlled Trial
. 2024 Dec 18:12:1470035.
doi: 10.3389/fpubh.2024.1470035. eCollection 2024.

Long-term impact of Diabetes Prevention Program interventions on walking endurance

Medha N Munshi  1 , Elizabeth M Venditti  2 , Ashley H Tjaden  3 , William C Knowler  4 , Edward J Boyko  5 , Roeland J W Middelbeek  1 , José A Luchsinger  6 , Christine G Lee  7 , Helen P Hazuda  8 , Marcel E Salive  9 , Sharon L Edelstein  3 , Thomas W Storer  10
Affiliations
Randomized Controlled Trial

Long-term impact of Diabetes Prevention Program interventions on walking endurance

Medha N Munshi et al. Front Public Health. .

Abstract

Objectives: Type 2 diabetes (T2D) and prediabetes are associated with poor walking endurance, a marker of physical function. We aimed to examine the long-term effects of metformin or intensive lifestyle intervention in adults at high risk of T2D on their 6-min walk test (6MWT) performance.

Methods: Participants were randomized in the 3-year Diabetes Prevention Program (DPP) to one of the three groups: lifestyle intervention, metformin, or placebo, and were subsequently followed in the DPP Outcomes Study. A 6MWT was conducted 20 years after randomization. Associations between DPP interventions and 6MWT completion (achieving a distance ≥200 m) were assessed using logistic regression. Among the test completers, differences in distance walked (6MWD) were evaluated using multivariable linear regression. Additional variables of interest included concomitant measures of body mass index (BMI) and grip strength along with mean measures of HbA1c and self-reported physical activity (PA).

Results: Data on 1830 participants were analyzed. The interventions were not associated with test completion or the 6MWD among test completers (362, 364, and 360 m in the lifestyle, metformin, and placebo groups, respectively, p = 0.8). Age, education, grip strength, and PA were each significantly associated with the 6MWT completion and the 6MWD after adjustment. Grip strength, PA, and education were positively associated with the 6MWD, while age, BMI, and HbA1c were negatively associated with the 6MWD.

Conclusion: We confirmed that the 6MWT is related to other measures of physical ability such as PA and grip strength in persons at risk for and with T2D, suggesting potential long-term benefits of maintaining a healthy lifestyle. However, we did not observe a sustained effect of the original randomized interventions.

Clinical trial registration: http://www.clinicaltrials.gov/ct/show/NCT00004992, identifier DPP NCT00004992; http://www.clinicaltrials.gov/ct/show/NCT00038727, identifier DPPOS NCT00038727.

Keywords: aging; diabetes; lifestyle; six-minute walk test; walking endurance.

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Conflict of interest statement

MM has been a consultant to Sanofi. JL has been a consultant to Merck KGaA and receives metformin drug and placebo from EV Serono, a subsidiary of Merck KGaA, for a clinical trial (NCT04098666). CL was an employee in the Division of Diabetes, Endocrinology, and Metabolic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases at the NIH at the time this research was conducted and is now an employee of Amgen. RM receives research support from Novo Nordisk. RM was an employee at Joslin Diabetes Center at the time this research was conducted and is now also an employee of Novo Nordisk. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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