Done at 21? A New Outcomes Paper for Diabetes Prevention
Is this a grand finale? Or a requiem? In The Lancet Diabetes & Endocrinology yesterday, a new 21-year analysis of outcomes from the Diabetes Prevention Program memorialized an epic study. Even after 21 years, the Diabetes Prevention Program yielded a 24% reduction in the cumulative risk of developing type 2 diabetes, along with detailed outcomes data that can guide precision medicine.
It is a stunning outcome for just 16 intensive lifestyle sessions delivered over six months, followed by monthly contacts. Peggy Bryant, an oncology nurse who volunteered as a patient in the study, describes the profound effect it had on her life:
“It changed the way I approached my health. The staff were so committed that it made you more committed.”
To be clear, this is what the “care” in healthcare should be all about.
Do We Care About Preventing This Chronic Disease?
But as Dhruv Khullar explains in a new article for the The New Yorker, there’s a jarring disconnect unfolding in health policy. On one hand, as Secretary of Health and Human Services, Robert F. Kennedy Jr. is talking big about preventing chronic diseases and “Making America Healthy Again.” Diabetes is at the top of the list of conditions that are making us unhealthy.
So the abrupt cancellation of a treasure trove of outcomes data for designing precision medicine interventions for diabetes prevention and harm reduction is inexplicable. Bipartisan leaders of the Congressional Diabetes Caucus urged Kennedy to “take necessary action” and ensure that insights for preventing diabetes from this study are not lost. It had no discernible effect.
The only explanation we can find for this situation is that Making America Healthy Again is empty talk. Richard Besser, a former CDC director, says it well:
“I have no argument with the need for government to do things better and more efficiently. But this is not about that. This is about tearing down institutions they don’t like. I doubt that rebuilding them will be possible in my lifetime.”
Care for health? Nope. Not from these jokers.
Click here for the new paper in The Lancet D&E and here for a commentary that goes with it. For Khullar’s new article in The New Yorker, click here.
Fallen Bricks, photograph by Tomas Castelazo, licensed under CC BY-SA 4.0
Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.
April 29, 2025
April 29, 2025 at 6:58 am, Michael Jones said:
Ted, post this or don’t, but I would like to ask you if you think you could possibly try to be a bit less overly politically biased in your commentary. I don’t necessarily disagree, but where were you on this when last year the Biden administration decided as of Jan 1 Federal employees would have a tier increase for obesity medications, placing them out of reach for a large number of my patients?! Pure objectivity, I realize, is impossible, but when disseminating information on a large scale, balanced perspective is important, especially from scientists whose “trust capital” has taken a large hit in recent years.
April 29, 2025 at 11:33 am, Ted said:
I respect your view, Michael, but I do not see this as a partisan issue. Both Republicans and Democrats support the NIH and diabetes prevention. The massive destruction of research infrastructure is a policy mistake, not an R vs D political issue.
Regarding the tiers of obesity medicines on federal employee benefit programs, I agree with your concern and have voiced it here:
https://conscienhealth.org/2024/12/exploiting-people-with-obesity-through-abusive-copays/
But that was an action of PBMs, not the federal government. Some plans did not change their tiers for obesity medicines, others did. The government does not dictate how they must run their formularies.
April 29, 2025 at 12:15 pm, Hope Warshaw said:
Ted –
Thank you for covering this important topic/publication!
One Q and 2 comments.
Q: the article notes one year ILI in DPP. Wasn’t the ILI the length of the DPP – 3 years? Please check.
2 comments:
1. PLEASE when writing about diabetes differentiate b/w T1 and T2. The DPP/DPPOS and discussion of prevent/delay diabetes is solely re: T2. RFK (and likely others) seem confused. (RFK should know better).
2. RFK and I assume others around him need basic education/knowledge about diabetes based on his comments within the announcement on food dyes when he stated: “Diabetes is an existential crisis…sugar is poison. Americans need to know that. It is poisoning us. It’s giving us a diabetes crisis….” and he went on providing more confusing/inaccurate content about the rise in rates of diabetes. Awful! Setting us back decades.
Thanks for your wonderful publication!
Hope Warshaw, MMSc, RD, CDCES
April 29, 2025 at 8:58 pm, Ted said:
Thanks, Hope. The DPP trial was for 16 intensive sessions delivered over six months. After that there were monthly check-ins and the trial was terminated a year early.
Regarding being specific to type 2, note that the opening sentences of this post describe the DPP as a program for preventing type 2 diabetes.