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"Reduction in the incidence of type 2
diabetes with lifestyle intervention or metformin,"
by W.C. Knowler
and 6 others, New England Journal of Medicine, 346(6): 393-403, 7
February 2002.
[Authors' affiliations: 35 U.S. institutions]
Abstract: "Background Type 2 diabetes affects approximately
8 percent of adults in the United States. Some risk factors--elevated plasma
glucose concentrations in the fasting state and after an oral glucose load,
overweight, and a sedentary lifestyle--are potentially reversible. We
hypothesized that modifying these factors with a lifestyle-intervention
program or the administration of metformin would prevent or delay the
development of diabetes. Methods We randomly assigned 3234 nondiabetic
persons with elevated fasting and post-load plasma glucose concentrations to
placebo, metformin (850 mg twice daily), or a lifestyle-modification program
with the goals of at least a 7 percent weight loss and at least 150 minutes of
physical activity per week. The mean age of the participants was 51 years, and
the mean body-mass index (the weight in kilograms divided by the square of the
height in meters) was 34.0; 68 percent were women, and 45 percent were members
of minority groups. Results The average follow-up was 2.8 years. The
incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the
placebo, metformin, and lifestyle groups, respectively. The lifestyle
intervention reduced the incidence
by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin
by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared
with placebo; the lifestyle intervention was significantly more effective than
metformin. To prevent one case of diabetes during a period of three years, 6.9
persons would have to participate in the lifestyle-intervention program, and
13.9 would have to receive metformin. Conclusions Lifestyle changes and
treatment with metformin both reduced the incidence of diabetes in persons at
high risk. The lifestyle intervention was more effective than metformin."
This 2002 report in the New England
Journal of Medicine was cited 130 times in current journal
articles
indexed by Thomson ISI during September-October 2003. Only one other medicine
paper published in the
last two years recorded a greater number of citations during that two-month
period. In fact, only two papers
in all of science, including reviews, surpassed this report's citation tally
during the September-October count.
Prior to the most recent bimonthly period, citations to the paper have accrued
as follows:
July-August 2003: 61 citations
May-June 2003: 48
March-April 2003: 49
January-February 2003: 49
November-December 2002: 35
September-October 2002: 37
July-August 2002: 4
May-June 2002: 4
Total citations to date: 417
Related information:
View
the top
10 scientists in Medicine; for the period of January 1, 1993 - October 31, 2003
SOURCE: Hot
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Watch®, available from the ISI
Research Services Group. Packaged on a CD-ROM that is mailed with each Science
Watch issue, the Hot
Papers Database contains data on hundreds of highly cited papers published
during the last two years. User interface permits searching by author,
organization, journal, field, and more. Total citations, as well as citations
accrued during successive bimonthly periods, can be assessed and graphed. An
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