Matthew J O'Brien1, Robert C Whitaker2, Daohai Yu3, Ronald T Ackermann4. 1. Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg, School of Medicine, 750N. Lake Shore Drive, 10th floor, Chicago, IL 60611, USA; Center for Community Health, Institute for Public Health and Medicine, Northwestern, University Feinberg School of Medicine, 750N. Lake Shore Drive, 6th floor, Chicago, IL 60611, USA. Electronic address: matthew.obrien1@northwestern.edu. 2. Department of Public Health, Temple University, 1938 Liacouras Walk, Philadelphia, PA 19140, USA; Department of Pediatrics, Temple University School of Medicine, 3500N. Broad Street, Philadelphia, PA, 19140, USA; Center for Obesity Research and Education, Temple University, 3223N. Broad Street, Suite, 175, Philadelphia, PA, 19140, USA. Electronic address: bobwhit@temple.edu. 3. Department of Clinical Sciences, Temple University School of Medicine, 3500N. Broad Street, Philadelphia, PA, 19140, USA. Electronic address: dyu@temple.edu. 4. Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg, School of Medicine, 750N. Lake Shore Drive, 10th floor, Chicago, IL 60611, USA; Center for Community Health, Institute for Public Health and Medicine, Northwestern, University Feinberg School of Medicine, 750N. Lake Shore Drive, 6th floor, Chicago, IL 60611, USA. Electronic address: r.ackermann@northwestern.edu.
Abstract
OBJECTIVE: Educational attainment is inversely associated with type 2 diabetes risk, but it is unknown whether education impacts individuals' diabetes prevention efforts. We examined the comparative efficacy of intensive lifestyle intervention and metformin by educational attainment among participants in the Diabetes Prevention Program (DPP), an ongoing U.S. multi-site trial beginning in 1996. METHODS: We studied 2,910 DPP participants randomized to receivelifestyle intervention, metformin, or placebo. Stratifying by educational attainment, diabetes incidence and relative risk reductions by treatment assignment were estimated using Cox proportional hazards regression. RESULTS:47% of participants had completed college and 53% had not. Compared to placebo, lifestyle participants who had completed college demonstrated a 68% reduction in diabetes incidence (95% CI=56, 77), whereas those with less education experienced a 47% risk reduction (95% CI=29, 61). For metformin participants, college graduates experienced a 49% relative risk reduction (95% CI=33, 62), compared to 23% (95% CI=1, 41) among those with lower educational attainment. There was a statistically significant education-by-treatment interaction with incident diabetes (p=0.03). CONCLUSIONS:Intensive lifestyle intervention and metformin have greater efficacy among highly educated individuals. Future efforts to deliver these treatments and study their dissemination may be more effective if tailored to individuals' educational background.
RCT Entities:
OBJECTIVE: Educational attainment is inversely associated with type 2 diabetes risk, but it is unknown whether education impacts individuals' diabetes prevention efforts. We examined the comparative efficacy of intensive lifestyle intervention and metformin by educational attainment among participants in the Diabetes Prevention Program (DPP), an ongoing U.S. multi-site trial beginning in 1996. METHODS: We studied 2,910 DPPparticipants randomized to receive lifestyle intervention, metformin, or placebo. Stratifying by educational attainment, diabetes incidence and relative risk reductions by treatment assignment were estimated using Cox proportional hazards regression. RESULTS: 47% of participants had completed college and 53% had not. Compared to placebo, lifestyle participants who had completed college demonstrated a 68% reduction in diabetes incidence (95% CI=56, 77), whereas those with less education experienced a 47% risk reduction (95% CI=29, 61). For metforminparticipants, college graduates experienced a 49% relative risk reduction (95% CI=33, 62), compared to 23% (95% CI=1, 41) among those with lower educational attainment. There was a statistically significant education-by-treatment interaction with incident diabetes (p=0.03). CONCLUSIONS: Intensive lifestyle intervention and metformin have greater efficacy among highly educated individuals. Future efforts to deliver these treatments and study their dissemination may be more effective if tailored to individuals' educational background.
Authors: Jonathan P Lacro; Laura B Dunn; Christian R Dolder; Susan G Leckband; Dilip V Jeste Journal: J Clin Psychiatry Date: 2002-10 Impact factor: 4.384
Authors: X R Pan; G W Li; Y H Hu; J X Wang; W Y Yang; Z X An; Z X Hu; J Lin; J Z Xiao; H B Cao; P A Liu; X G Jiang; Y Y Jiang; J P Wang; H Zheng; H Zhang; P H Bennett; B V Howard Journal: Diabetes Care Date: 1997-04 Impact factor: 19.112
Authors: J Tuomilehto; J Lindström; J G Eriksson; T T Valle; H Hämäläinen; P Ilanne-Parikka; S Keinänen-Kiukaanniemi; M Laakso; A Louheranta; M Rastas; V Salminen; M Uusitupa Journal: N Engl J Med Date: 2001-05-03 Impact factor: 91.245
Authors: William C Knowler; Elizabeth Barrett-Connor; Sarah E Fowler; Richard F Hamman; John M Lachin; Elizabeth A Walker; David M Nathan Journal: N Engl J Med Date: 2002-02-07 Impact factor: 91.245
Authors: Rena R Wing; Richard F Hamman; George A Bray; Linda Delahanty; Sharon L Edelstein; James O Hill; Edward S Horton; Mary A Hoskin; Andrea Kriska; John Lachin; Elizabeth J Mayer-Davis; Xavier Pi-Sunyer; Judith G Regensteiner; Beth Venditti; Judith Wylie-Rosett Journal: Obes Res Date: 2004-09
Authors: Katherine J W Baucom; Tali Bauman; Manuel Gutierrez Chavez; Yanina Nemirovsky; Monique C Aguirre; Carmen Ramos; Anu Asnaani; Cassidy A Gutner; Natalie D Ritchie; Megha Shah Journal: Transl Behav Med Date: 2022-08-17 Impact factor: 3.626
Authors: Bradley M Appelhans; Simone A French; Tamara Olinger; Michael Bogucki; Imke Janssen; Elizabeth F Avery-Mamer; Lisa M Powell Journal: Appetite Date: 2018-03-15 Impact factor: 3.868
Authors: Alberly Perez; Victor A Alos; Adam Scanlan; Catarina M Maia; Adam Davey; Robert C Whitaker; Gary D Foster; Ronald T Ackermann; Matthew J O'Brien Journal: Contemp Clin Trials Date: 2015-10-24 Impact factor: 2.226
Authors: Todd Gilmer; Patrick J O'Connor; Jeffrey S Schiff; Gretchen Taylor; Gabriela Vazquez-Benitez; Joyce E Garrett; Houa Vue-Her; Sarah Rinn; Julie Anderson; Jay Desai Journal: Health Serv Res Date: 2018-05-16 Impact factor: 3.402