Crandall Jill, Schade David, Ma Yong, Fujimoto Wilfred Y, Barrett-Connor Elizabeth, Fowler Sarah, Dagogo-Jack Sam, Andres Reubin
Diabetes Prevention Program Coordinating Center, The Biostatistics Center, George Washington University, 6100 Executive Boulevard, Suite 750, Rockville, MD 20852, USA.
J Gerontol A Biol Sci Med Sci. 2006 Oct;61(10):1075-81. doi: 10.1093/gerona/61.10.1075.
The incidence of type 2 diabetes increases with age. It is unknown whether interventions to prevent diabetes are as effective in elderly persons as in younger adults.
The Diabetes Prevention Program (DPP) demonstrated that an intensive lifestyle intervention (ILS) or metformin could prevent or delay diabetes. A predefined secondary outcome of DPP was to determine if treatment effects varied by age.
At baseline, participants aged 60-85 years were leaner and had the best insulin sensitivity and lowest insulin secretion compared to younger age groups. Diabetes incidence rates did not differ by age in the placebo group, but ILS was more effective with increasing age (6.3, 4.9, and 3.3 cases per 100 person-years, in the 25-44, 45-59, and 60-85 year age groups, respectively; p(trend) =.007). Participants aged 60-85 years had the most weight loss and metabolic equivalent (MET)-hours of physical activity. The metformin group showed a trend toward higher diabetes incidence among older participants (6.7, 7.7, and 9.3 cases per 100 person-years in the 25-44, 45-59, and 60-85 year age groups, respectively; p(trend) =.07); and diabetes risk increased with age (hazard ratio [age 60-85 vs 25-44] 1.63, p =.02), after adjusting for the greater weight loss in the 60-85 year age group.
Lifestyle modification was exceptionally effective in preventing diabetes in older individuals; this finding was largely explained by greater weight loss and physical activity. The limited effectiveness of metformin in older persons may reflect age-related differences in insulin action and secretion. A lifestyle modification program can be recommended for older individuals at high risk for type 2 diabetes.
2型糖尿病的发病率随年龄增长而增加。预防糖尿病的干预措施在老年人中是否与在年轻人中一样有效尚不清楚。
糖尿病预防计划（DPP）表明，强化生活方式干预（ILS）或二甲双胍可以预防或延缓糖尿病。DPP的一个预先定义的次要结果是确定治疗效果是否因年龄而异。
在基线时，与年轻年龄组相比，60 - 85岁的参与者更瘦，胰岛素敏感性最佳，胰岛素分泌最低。安慰剂组的糖尿病发病率在各年龄组之间没有差异，但ILS的有效性随年龄增加而提高（25 - 44岁、45 - 59岁和60 - 85岁年龄组每100人年的病例数分别为6.3、4.9和3.3例；p趋势 = 0.007）。60 - 85岁的参与者体重减轻最多，体力活动的代谢当量（MET）小时数最多。二甲双胍组在老年参与者中显示出糖尿病发病率更高的趋势（25 - 44岁、45 - 59岁和60 - 85岁年龄组每100人年的病例数分别为6.7、7.7和9.3例；p趋势 = 0.07）；在调整60 - 85岁年龄组更大的体重减轻后，糖尿病风险随年龄增加（风险比[60 - 85岁与25 - 44岁相比]1.63，p = 0.02）。
生活方式改变在预防老年人糖尿病方面非常有效；这一发现很大程度上可以通过更多的体重减轻和体力活动来解释。二甲双胍在老年人中的有效性有限可能反映了胰岛素作用和分泌的年龄相关差异。对于2型糖尿病高危老年人，可推荐生活方式改变计划。
