Abstract
Background: Prevention of type 2 diabetes mellitus (T2DM) among high-risk individuals is a global public health priority. Lifestyle modification (LSM) and pharmacological interventions like metformin and pioglitazone have shown promising results in the prevention of T2DM.
Objectives: This study was conducted to compare the effectiveness of lifestyle modification alone, lifestyle modification + metformin, and lifestyle modification + pioglitazone in preventing T2DM among high-risk individuals.
Methods: This prospective interventional study was conducted from 2020 to 2023, among the 16-35 young Bangladeshi Adults. A total 1,405 participants were randomly assigned to lifestyle modification alone, lifestyle modification + metformin, and lifestyle modification + pioglitazone groups, respectively. The participants were similar in terms of baseline demographic and clinical characteristics (p > 0.05).
Results: The incidence rate of diabetes was significantly higher in the LSM group than in the LSM+Met and LSM+Pio groups. The incidence rate per 100 person-years was 10.1, 6.4, and 5.0, respectively. The adjusted hazard ratio was 0.63 (95% CI, 0.52 to 0.76) for the LSM+Met group and 0.49 (95% CI, 0.40 to 0.60) for the LSM+Pio group. All groups showed a significant reduction in weight, BMI, and waist circumference. However, a greater reduction in weight was noted in the LSM+Met group than in the other groups. The reduction in weight was -5.2±2.1 kg, -3.5±1.5 kg, and -3.3±1.5 kg, respectively. A reduction in HbA1c and FBS was noted in all three groups. However, a greater reduction in HbA1c and FBS
Conclusions: Both metformin and pioglitazone added significantly to the preventive effect of lifestyle modification against diabetes, and LSM+Pio had the lowest incidence of diabetes and the largest improvements in metabolism. However, safety profiles differ and should inform treatment choices.