MoreYears.news Evidence map

Metabolic health · claim–evidence map

Metabolic health claim–evidence map

Trace 12 governed claims from DPP/DPPOS, Look AHEAD, and ACCORD to their primary reports, registries, corrections, and limits.

What this is: a traceable projection of already published, source-reviewed claims. It does not score studies, rank interventions, or recommend care.

Browse all governed claims →

Overview

Evidence at a glance

Counts describe this governed map, not evidence strength.

Analyses
3
Claims
12
Source records
16
Correction flags
7

How relationships are labeled

Direct supportContradictionIndirect contextInsufficient evidence

These labels describe a claim–source relationship. They are not grades or rankings.

Connected analysis

dpp dppos diabetes microvascular outcomes

Read the analysis →

Lifestyle and metformin delayed diabetes; the overall aggregate microvascular outcome did not differ by randomized group.

Direct supportM69-DPP-01

At 15 years, cumulative diabetes incidence was 55% with lifestyle, 56% with metformin and 62% with placebo; hazard ratios were 0.73 and 0.82 versus placebo.

Evidence role
governed claim
Population or model
Adults with impaired glucose tolerance and BMI at least 24 kg/m² in the original DPP cohort
Comparator
Intensive lifestyle or metformin versus placebo
Outcome
Diabetes incidence
Design and maturity
Long randomized follow-up with diabetes incidence benefit and an overall null aggregate microvascular comparison
Result
At 15 years, cumulative diabetes incidence was 55% with lifestyle, 56% with metformin and 62% with placebo; hazard ratios were 0.73 and 0.82 versus placebo.
Boundary
No demonstrated cardiovascular, mortality, healthspan or lifespan benefit
Limitations
Post-DPP lifestyle exposure across groups, unmasked follow-up treatment and diminishing separation
Funding and conflicts
NIDDK/NIH support; governing paper declares no conflicts.
Correction state
No linked correction/retraction; DPPOS registry status stale
Exact source identities and links
Insufficient evidenceM69-DPP-02

Overall aggregate microvascular prevalence did not differ significantly by original randomized group: 11.3% lifestyle, 13.0% metformin and 12.4% placebo.

Evidence role
governed claim
Population or model
Surviving DPP participants in DPPOS
Comparator
Original randomized groups
Outcome
Aggregate retinopathy, nephropathy and neuropathy prevalence
Design and maturity
Long randomized follow-up with diabetes incidence benefit and an overall null aggregate microvascular comparison
Result
Overall aggregate microvascular prevalence did not differ significantly by original randomized group: 11.3% lifestyle, 13.0% metformin and 12.4% placebo.
Boundary
No overall randomized microvascular benefit
Limitations
End-study prevalence composite and shared lifestyle exposure
Funding and conflicts
NIDDK/NIH support; governing paper declares no conflicts.
Correction state
No linked correction/retraction; DPPOS registry status stale
Exact source identities and links
  • source:pmid-2637705426377054 · primary-randomized-follow-upCorrection state: none-linked-as-of-2026-08-26
  • source:pmc-4623946PMC4623946 · full-reportCorrection state: none-linked-as-of-2026-08-26
Insufficient evidenceM69-DPP-03

Women-only differences and the lower prevalence among participants who did not develop diabetes are secondary subgroup or exposure-defined findings.

Evidence role
governed claim
Population or model
DPPOS women subgroup and diabetes-status groups
Comparator
Subgroup/exposure-defined comparisons
Outcome
Aggregate microvascular prevalence
Design and maturity
Long randomized follow-up with diabetes incidence benefit and an overall null aggregate microvascular comparison
Result
Women-only differences and the lower prevalence among participants who did not develop diabetes are secondary subgroup or exposure-defined findings.
Boundary
No whole-cohort randomized microvascular effect
Limitations
Multiplicity, subgroup scope and nonrandomized diabetes-status comparison
Funding and conflicts
NIDDK/NIH support; governing paper declares no conflicts.
Correction state
No linked correction/retraction; DPPOS registry status stale
Exact source identities and links
  • source:pmid-2637705426377054 · primary-randomized-follow-upCorrection state: none-linked-as-of-2026-08-26
  • source:pmc-4623946PMC4623946 · full-reportCorrection state: none-linked-as-of-2026-08-26
Insufficient evidenceM69-DPP-04

Later 21-year analyses did not find fewer major cardiovascular events or deaths by original lifestyle or metformin assignment.

Evidence role
governed claim
Population or model
Original DPP cohort under prolonged follow-up
Comparator
Original lifestyle or metformin assignment versus placebo
Outcome
Major cardiovascular events and mortality
Design and maturity
Long randomized follow-up with diabetes incidence benefit and an overall null aggregate microvascular comparison
Result
Later 21-year analyses did not find fewer major cardiovascular events or deaths by original lifestyle or metformin assignment.
Boundary
No proof that delaying diabetes has no value
Limitations
Intervention convergence, outside treatment and prolonged follow-up
Funding and conflicts
NIDDK/NIH support; governing paper declares no conflicts.
Correction state
No linked correction/retraction; DPPOS registry status stale
Exact source identities and links

Connected analysis

look ahead cardiovascular outcomes

Read the analysis →

Weight and risk factors changed, but the primary cardiovascular outcome was not significantly reduced.

Direct supportM69-LA-01

The primary cardiovascular composite occurred in 403 intensive-lifestyle and 418 support/education participants; hazard ratio 0.95, P=0.51.

Evidence role
governed claim
Population or model
Adults age 45–75 with type 2 diabetes and overweight or obesity who could complete an exercise test
Comparator
Structured intensive lifestyle versus diabetes support and education
Outcome
Cardiovascular death, nonfatal myocardial infarction, nonfatal stroke or hospitalization for angina
Design and maturity
Large randomized cardiovascular-outcome trial stopped for futility
Result
The primary cardiovascular composite occurred in 403 intensive-lifestyle and 418 support/education participants; hazard ratio 0.95, P=0.51.
Boundary
No statistically significant cardiovascular-event reduction
Limitations
Stopped for futility, evolving medical care and narrowing weight contrast
Funding and conflicts
NIH/HHS and listed institutional/corporate support; corporate supporters reportedly had no design, analysis or reporting role; disclosures linked.
Correction state
2014 correction incorporated
Exact source identities and links
  • source:doi-look-ahead10.1056/NEJMoa1212914 · corrected-full-reportCorrection state: corrected-2014-05-08
  • source:pmid-2379613123796131 · primary-randomized-reportCorrection state: corrected-by-NEJMx140022
  • source:nct-00017953NCT00017953 · trial-registryCorrection state: completed-last-updated-2023-08-02
Direct supportM69-LA-02

Mean weight loss was 8.6% versus 0.7% at year one and 6.0% versus 3.5% at study end.

Evidence role
governed claim
Population or model
Look AHEAD randomized cohort
Comparator
Intensive lifestyle versus support and education
Outcome
Body weight
Design and maturity
Large randomized cardiovascular-outcome trial stopped for futility
Result
Mean weight loss was 8.6% versus 0.7% at year one and 6.0% versus 3.5% at study end.
Boundary
No evidence that the weight difference caused fewer cardiovascular events or longer life
Limitations
Structured trial program and selected participants
Funding and conflicts
NIH/HHS and listed institutional/corporate support; corporate supporters reportedly had no design, analysis or reporting role; disclosures linked.
Correction state
2014 correction incorporated
Exact source identities and links
  • source:doi-look-ahead10.1056/NEJMoa1212914 · corrected-full-reportCorrection state: corrected-2014-05-08
Direct supportM69-LA-03

Several risk factors and fitness improved more initially while treatment patterns and group differences narrowed over time.

Evidence role
governed claim
Population or model
Look AHEAD randomized cohort
Comparator
Intensive lifestyle versus support and education
Outcome
HbA1c, fitness and cardiovascular risk factors
Design and maturity
Large randomized cardiovascular-outcome trial stopped for futility
Result
Several risk factors and fitness improved more initially while treatment patterns and group differences narrowed over time.
Boundary
No substitute for a cardiovascular-event benefit
Limitations
Multiple secondary outcomes and evolving co-treatment
Funding and conflicts
NIH/HHS and listed institutional/corporate support; corporate supporters reportedly had no design, analysis or reporting role; disclosures linked.
Correction state
2014 correction incorporated
Exact source identities and links
  • source:doi-look-ahead10.1056/NEJMoa1212914 · corrected-full-reportCorrection state: corrected-2014-05-08
Indirect contextM69-LA-04

Self-reported but not adjudicated fracture rates differed; a 2014 correction added hospitalization for angina to one secondary-composite label without changing the primary result.

Evidence role
governed claim
Population or model
Look AHEAD randomized cohort
Comparator
Intensive lifestyle versus support and education
Outcome
Fractures and correction status
Design and maturity
Large randomized cardiovascular-outcome trial stopped for futility
Result
Self-reported but not adjudicated fracture rates differed; a 2014 correction added hospitalization for angina to one secondary-composite label without changing the primary result.
Boundary
No general fracture harm or change to the governing cardiovascular conclusion
Limitations
Secondary safety outcome and reporting-method difference
Funding and conflicts
NIH/HHS and listed institutional/corporate support; corporate supporters reportedly had no design, analysis or reporting role; disclosures linked.
Correction state
2014 correction incorporated
Exact source identities and links

Connected analysis

accord intensive glycemia mortality

Read the analysis →

The intensive target strategy increased mortality and did not significantly reduce the primary cardiovascular outcome.

Direct supportM69-ACC-01

ACCORD randomized 10,251 high-risk adults with type 2 diabetes to multi-drug strategies targeting HbA1c below 6.0% or 7.0–7.9%; achieved medians were 6.4% and 7.5%.

Evidence role
governed claim
Population or model
Adults with established type 2 diabetes plus cardiovascular disease or added risk factors
Comparator
Intensive multi-drug glycemia target strategy versus standard strategy
Outcome
HbA1c target and achieved levels
Design and maturity
Large randomized cardiovascular-outcome trial with an early-stopped intensive glycemia arm
Result
ACCORD randomized 10,251 high-risk adults with type 2 diabetes to multi-drug strategies targeting HbA1c below 6.0% or 7.0–7.9%; achieved medians were 6.4% and 7.5%.
Boundary
No effect estimate for people without diabetes or any single treatment
Limitations
Selected high-risk population and multi-drug strategy
Funding and conflicts
NHLBI/NIH/CDC support; manufacturers supplied medicines/equipment and multiple author industry relationships were disclosed.
Correction state
No linked correction/retraction
Exact source identities and links
  • source:doi-accord10.1056/NEJMoa0802743 · full-reportCorrection state: none-linked-as-of-2026-08-26
  • source:pmid-1853991718539917 · primary-randomized-reportCorrection state: none-linked-as-of-2026-08-26
  • source:nct-00000620NCT00000620 · trial-registryCorrection state: completed-last-updated-2016-11-22
Direct supportM69-ACC-02

The primary cardiovascular outcome occurred in 352 versus 371 participants; hazard ratio 0.90, P=0.16.

Evidence role
governed claim
Population or model
ACCORD high-risk type 2 diabetes cohort
Comparator
Intensive versus standard glycemia strategy
Outcome
Nonfatal myocardial infarction, nonfatal stroke or cardiovascular death
Design and maturity
Large randomized cardiovascular-outcome trial with an early-stopped intensive glycemia arm
Result
The primary cardiovascular outcome occurred in 352 versus 371 participants; hazard ratio 0.90, P=0.16.
Boundary
No statistically significant reduction in major cardiovascular events
Limitations
Intensive arm stopped early
Funding and conflicts
NHLBI/NIH/CDC support; manufacturers supplied medicines/equipment and multiple author industry relationships were disclosed.
Correction state
No linked correction/retraction
Exact source identities and links
  • source:pmid-1853991718539917 · primary-randomized-reportCorrection state: none-linked-as-of-2026-08-26
  • source:doi-accord10.1056/NEJMoa0802743 · full-reportCorrection state: none-linked-as-of-2026-08-26
Direct supportM69-ACC-03

Deaths were 257 versus 203; hazard ratio 1.22, P=0.04, prompting early discontinuation of intensive therapy.

Evidence role
governed claim
Population or model
ACCORD high-risk type 2 diabetes cohort
Comparator
Intensive versus standard glycemia strategy
Outcome
All-cause mortality
Design and maturity
Large randomized cardiovascular-outcome trial with an early-stopped intensive glycemia arm
Result
Deaths were 257 versus 203; hazard ratio 1.22, P=0.04, prompting early discontinuation of intensive therapy.
Boundary
No claim that lower glucose, diabetes care, diet or exercise generally increases mortality
Limitations
Mechanism unresolved and strategy-specific; later excess attenuated
Funding and conflicts
NHLBI/NIH/CDC support; manufacturers supplied medicines/equipment and multiple author industry relationships were disclosed.
Correction state
No linked correction/retraction
Exact source identities and links
  • source:pmid-1853991718539917 · primary-randomized-reportCorrection state: none-linked-as-of-2026-08-26
  • source:doi-accord10.1056/NEJMoa0802743 · full-reportCorrection state: none-linked-as-of-2026-08-26
  • source:pmid-2682232626822326 · later-follow-upCorrection state: none-linked-as-of-2026-08-26
Insufficient evidenceM69-ACC-04

Assistance-requiring hypoglycemia and weight gain over 10 kg were more frequent; hypoglycemia did not explain the mortality difference and a different intensive strategy in ADVANCE did not increase mortality.

Evidence role
governed claim
Population or model
ACCORD cohort with independent ADVANCE countercontext
Comparator
Different intensive and standard glucose-control strategies
Outcome
Safety and applicability
Design and maturity
Large randomized cardiovascular-outcome trial with an early-stopped intensive glycemia arm
Result
Assistance-requiring hypoglycemia and weight gain over 10 kg were more frequent; hypoglycemia did not explain the mortality difference and a different intensive strategy in ADVANCE did not increase mortality.
Boundary
No single causal mechanism or cross-trial efficacy ranking
Limitations
Mechanism remains unresolved and trials differ materially
Funding and conflicts
NHLBI/NIH/CDC support; manufacturers supplied medicines/equipment and multiple author industry relationships were disclosed.
Correction state
No linked correction/retraction
Exact source identities and links
  • source:pmid-1853991718539917 · primary-randomized-reportCorrection state: none-linked-as-of-2026-08-26
  • source:pmid-2006135820061358 · secondary-safety-analysisCorrection state: none-linked-as-of-2026-08-26
  • source:pmid-1853991618539916 · independent-randomized-countercontextCorrection state: none-linked-as-of-2026-08-26

Sources

Exact records used on this page

Stable IDIdentifierRecord typeLinkCorrection state
source:pmid-2637705426377054primary-randomized-follow-upOpen recordnone-linked-as-of-2026-08-26
source:pmc-4623946PMC4623946full-reportOpen recordnone-linked-as-of-2026-08-26
source:nct-00004992NCT00004992trial-registryOpen recordcompleted
source:pmid-3560360035603600later-follow-upOpen recordnone-linked-as-of-2026-08-26
source:pmid-3469703334697033later-follow-upOpen recordnone-linked-as-of-2026-08-26
source:nct-00038727NCT00038727trial-registryOpen recordunknown-status-last-verified-2021-12
source:doi-look-ahead10.1056/NEJMoa1212914corrected-full-reportOpen recordcorrected-2014-05-08
source:pmid-2379613123796131primary-randomized-reportOpen recordcorrected-by-NEJMx140022
source:nct-00017953NCT00017953trial-registryOpen recordcompleted-last-updated-2023-08-02
source:doi-look-ahead-correction10.1056/NEJMx140022correctionOpen recordincorporated
source:doi-accord10.1056/NEJMoa0802743full-reportOpen recordnone-linked-as-of-2026-08-26
source:pmid-1853991718539917primary-randomized-reportOpen recordnone-linked-as-of-2026-08-26
source:nct-00000620NCT00000620trial-registryOpen recordcompleted-last-updated-2016-11-22
source:pmid-2682232626822326later-follow-upOpen recordnone-linked-as-of-2026-08-26
source:pmid-2006135820061358secondary-safety-analysisOpen recordnone-linked-as-of-2026-08-26
source:pmid-1853991618539916independent-randomized-countercontextOpen recordnone-linked-as-of-2026-08-26

Limitations

What this map does not do

Review history

Separate evidence and prose checks

  1. Governed evidence review

    Primary reports, registries, limitations, funding/conflicts, and correction state were locked in the source claim map before publication.

  2. Identifier and correction carry-forward

    Every rendered source ID was rejoined to one exact governed URL; duplicate IDs, missing records, and lost correction states fail validation.

  3. Orientation-prose review

    Headings, labels, and summaries were reviewed separately for neutral language, no treatment ranking, and no personal recommendation.

Generated from data/knowledge-system/seventeenth-coverage-claim-map.json. Source-review date: 2026-08-26.