Competition for a Popular Diabetes Drug
A once-celebrated diabetes medication, metformin, known for its potential in promoting longevity, is now facing some competition.
This long-established drug has been praised not just for its effectiveness in treating Type 2 diabetes, but also for, well, possibly lowering the risk of long COVID and even slowing the aging process. However, a recent study published in JAMA suggests that a different approach may actually be more effective in lowering the chances of developing multiple chronic diseases over two decades.
What’s interesting—this approach is accessible to nearly everyone.
The study analyzed data from participants involved in the Diabetes Prevention Program (DPP) and its follow-up, the Diabetes Prevention Program Outcomes Study (DPPOS), which tracked thousands of adults from 1996 to 2021.
The standout strategy? Engaging in rigorous exercise coupled with a nutritious, balanced diet.
Researchers discovered that for adults with prediabetes, a lifestyle change that included a low-fat, low-calorie diet and at least 150 minutes of physical activity per week was linked to a reduced burden of multimorbidity over the lengthy follow-up period.
On the flip side, metformin didn’t outperform a placebo.
So, what does multimorbidity mean? It refers to having two or more chronic health issues simultaneously. In this study, researchers examined 15 prevalent conditions within the Medicare claims database, including hypertension, cancer, and Alzheimer’s disease.
The original program enrolled 3,234 participants who were at high risk for developing diabetes. They were assigned randomly to receive either intensive lifestyle interventions, metformin, or a placebo for three years before continuing into a long-term follow-up study.
Among the 1,173 participants enrolled in Medicare, tracked over 21 years, 82% from the lifestyle group developed multimorbidity. This is compared to 85% in the metformin group and 87% in the placebo group.
Researchers believe this study is vital, particularly because efforts to prevent or slow the emergence of multimorbidity in practical medical settings haven’t been very effective. Once patients start acquiring multiple health issues, it’s challenging for doctors to halt that progression, as these conditions often exacerbate each other over time.
This concern becomes even more significant in light of what the researchers termed “high-cost condition dyads”—combinations of chronic diseases like heart failure paired with kidney issues, or cancer and mental health disorders—that contribute significantly to healthcare costs and complexities.
With this context, the authors explored metformin and lifestyle changes since both have already been shown to lower the risk of Type 2 diabetes in high-risk individuals.
The pressing question was whether either method could extend these benefits and help mitigate long-term multimorbidity.
Dr. Shirin Jaggi, DO, an endocrinologist at Northwell Health, described the findings as “powerful.” It allows her to communicate to patients that their health strategy doesn’t rely solely on medications.
She pointed out that lifestyle changes aren’t universally applicable—they can vary widely from person to person, and it’s essential to adopt healthier eating and fitness routines at a manageable pace over time.
“We should start slowly and progressively increase,” Dr. Jaggi advised, highlighting the need for regular check-ins with patients to measure their progress. For someone who hasn’t been active, even adding 10 to 15 minutes of activity once, or maybe twice, a day could be a great start.
As the population ages, multimorbidity has become more frequent among adults over 65. Preventing or postponing its onset is recognized as a major hurdle in contemporary healthcare.
“Being able to share with patients that there’s an effective alternative beyond medication—something potentially more powerful, I think is truly remarkable,” Dr. Jaggi remarked. “It really motivates patients.”
