Abstract 1081: Lifestyle and Metformin Treatment Favorably Influence Lipoprotein Subfraction Distribution in the Diabetes Prevention Program
The dyslipidemia of diabetes can occur in those with prediabetes and increases atherosclerosis risk in these individuals. Lipoprotein subfractionation reveals the dyslipidemia to result from overproduction of large VLDL particles causing accumulation of small LDL and reduction in HDL size. While interventions that slow diabetes development may have beneficial effects on lipids, their effects on lipoprotein subfraction distribution is unknown. We report the effects of a one-year intervention of intensive lifestyle (ILS) and metformin (MET) compared to placebo (PLA) treatment in a subset of 2026 subjects with impaired glucose tolerance studied in the Diabetes Prevention Program, on lipoprotein size (z) and particle number (p) using magnetic resonance technology.
Results: Compared to PLA and MET, ILS reduced VLDLz and large VLDLp, while increasing LDLz predominantly by reducing small LDLp. MET had similar but more modest effects on VLDLz, LDLz and small LDLp compared to PLA. Both interventions increased HDLz, although ILS was more robust; ILS increased large HDLp, but decreased small HDLp, whereas MET increased large and small HDLp, increasing total HDLp. A fourth DPP group receiving troglitazone had to be prematurely discontinued after an average of 8 months exposure, but analysis (n=78) revealed that troglitazone had effects similar to ILS.
Conclusions: Since ILS significantly lowered VLDL and LDL particle numbers, with MET having milder but parallel effects, and both interventions altered lipoprotein size distribution in apparently favorable directions, these changes constitute treatment effects that could have benefit for the vascular complications of diabetes.