Investigators advocate to reinstate Diabetes Prevention Program Outcome Study funding
Key takeaways:
- Diabetes Prevention Program investigators learned March 10 that government funding had been terminated.
- They said the program’s ongoing research may cease within weeks if funding is not restored.
The future of the landmark Diabetes Prevention Program is in doubt after it lost federal funding for an ongoing long-term outcomes study and was forced to stop operations, according to the chair of the program.
On March 10, investigators on the Diabetes Prevention Program Outcomes Study (DPPOS) received an email from Columbia University that the DPPOS funding had been “terminated,” according to David M. Nathan, MD, chair of the Diabetes Prevention Program, professor of medicine at Harvard Medical School and founder of the Diabetes Clinical Research Center at Massachusetts General Hospital. Nathan said the email went on to state all ongoing activities associated with the program had to immediately stop. There was no explanation on why the funding was canceled, according to Nathan.
“We have yet to see a formal announcement from the NIH,” Nathan told Healio. “We have no idea who signed off on it or where it came from.”
Nathan said DPPOS investigators believe that the loss of funding is connected to the federal government’s decision to cut about $400 million in federal grants to Columbia, one of the sites participating in the study. The program was receiving funding to conduct the Diabetes Prevention Program Outcomes Study-4 (DPPOS-4), a study assessing the development of Alzheimer’s disease and other related dementias among 1,700 adults who have participated in the program since the initial study launched in 1996.
According to a letter from Nathan and the program’s other principal investigators, the NIH requires multicenter grant recipients to designate one site as the primary recipient of the grant funding. The primary recipient then distributes the funding to the remaining sites. Columbia University was the primary recipient for DPPOS-4 grant funding, leading the program to lose all its funding when the federal government withheld grants from Columbia. This is despite about 90% of the grant funding being sent to other institutions, according to Nathan.
“From our point of view, we were just innocent bystanders here of what is going on between Columbia and the federal government,” Nathan said.
Nathan said the loss of funding had an immediate effect on the program, resulting in the immediate cancellation of appointments with participants and concerns about sites being unable to pay staff or afford rent for facilities. Principal investigators with the program are now trying to contact members of Congress and other leaders in the federal government to get funding restored before time runs out.
“We can’t find alternative sources of funding to support our staff for more than a few weeks,” Nathan said March 24. “This is really urgent.”
The Diabetes Prevention Program’s loss of funding is just one example of a funding crisis that could strike other research programs, according to Richard E. Pratley, MD, a Healio | Endocrine Today Co-editor and the Samuel E. Crockett Chair in Diabetes Research and medical director of AdventHealth Diabetes Institute.
“Everybody who is in a position of leadership at a university and doing biomedical research, especially, is very worried,” Pratley told Healio.
‘A true missed opportunity’
The initial study from the Diabetes Prevention Program, published in The New England Journal of Medicine in 2002, had a major impact on how health care professionals approach treating diabetes, according to Pratley. The study found metformin or lifestyle intervention delayed or prevented the development of type 2 diabetes among people at high risk who had elevated plasma glucose levels and overweight or obesity at baseline.
After the publication of the initial study, participants were invited to continue in the DPPOS, a multiphase program assessing a variety of long-term health outcomes in the Diabetes Prevention Program cohort, including further prevention of diabetes, major adverse cardiovascular events, microvascular outcomes, cancer and more. The program’s newest research, DPPOS-4, was to assess the risk factors for the development of Alzheimer’s disease and related dementias among the study group.
Nathan said one of the most disappointing parts about the loss of funding for the DPPOS is that its research aligns with the federal government’s desire to combat chronic diseases.
“The work we’re doing in diabetes prevention, studying long-term diabetes [outcomes], and now for the last couple of years, studying Alzheimer’s and related dementias, is right in line with what the administration wants to be studying,” Nathan said.
Pratley said the Diabetes Prevention Program and DPPOS have made a huge contribution to the understanding of diabetes prevention and diabetes-related outcomes across more than 20 years. If funding is not restored, Pratley said, it will be difficult to replicate the strength of the program’s previous research.
“The beauty of the Diabetes Prevention Program was this well-characterized, established population with experienced investigators doing [research] in a consistent fashion,” Pratley said. “If it is switched to a different follow-up through medical records, you lose a lot of that precision and you won’t have nearly the sensitivity for measuring outcomes. ... Granular detail that helps understand pathways and pathophysiology is going to be lost because we won’t be collecting biospecimens. We won’t be doing specialized testing anymore. I think that’s shortsighted and a true missed opportunity.”
If funding is not reinstated, the program could end suddenly for the approximately 1,700 adults still enrolled.
“Whenever somebody cancels programs like this, they forget that there are human beings involved,” Nathan said. “We can’t ethically cut off connections with them. We generate research data that, not infrequently, have clinical relevance.”
The lack of funding could also lead to staff members being out of work, according to Nathan. He said that nurse coordinators, clinical research coordinators and other employees who have been working on the study could soon have to look for new jobs if funding is not reacquired.
Advocating for funding
As of publication time, uncertainty still surrounds the future of the Diabetes Prevention Program. According to reporting from The New York Times on March 21, Columbia University has agreed to meet demands of the Trump administration and make several policy changes in hopes of getting its government funding restored.
Despite this, Nathan is concerned a resolution may not happen quickly enough to prevent the Diabetes Prevention Program from shutting down. The program’s investigators published a letter March 20 advocating for the restoration of funding, and key leaders in the research community have reached out to members of the diabetes caucus in Congress to see whether they can assist with resolving the issue.
Major endocrinology societies such as the American Diabetes Association and the Endocrine Society released statements advocating for funding to be restored to the program.
“Eliminating funding for the [Diabetes Prevention Program]/DPPOS 30-year nationwide study of program participants means the loss of a decade’s worth of important findings and progress toward diabetes prevention and understanding Alzheimer’s disease and associated dementia in diabetes, a recent focus of the study,” the ADA said in a statement. “The ADA is engaging with congressional leaders on diabetes and the Trump administration to express our concerns, especially as this funding decision seems to be at odds with the Department of Health and Human Services’ commitment to combatting chronic disease in the United States.”
“Preventing and delaying the onset of diabetes can help reduce other chronic conditions, such as heart and kidney disease, and control health care costs,” the Endocrine Society said in its statement. “The direct and indirect costs of treating diagnosed cases of diabetes nationwide total an estimated $413 billion in 2022, according to the CDC. Eliminating the Diabetes Prevention Program contradicts the country’s commitment to addressing chronic disease and making America healthy.”
Long-term ramifications
The loss of funding for the Diabetes Prevention Program is just one example of a shift occurring in medicine and science in general, according to Pratley. He said institutions and researchers across the country are concerned about losing funding. A decrease in public money for scientific research could not only slow scientific progress but also discourage people from pursuing medical research as a career.
“You’ve already seen that programs are not enrolling new PhD candidates or fellows into training programs,” Pratley said. “There’s going to be a lost generation of very talented researchers. They will go off and do something else. But they’re not going to be contributing to the health of our country.”
Funding cuts will have an impact beyond research and could have downstream effects on hospitals, drug development, medical guidance, education programs and more, Pratley told Healio.
“There’s this ecosystem that exists around science for a purpose, to help support, lift, communicate and educate,” Pratley said. “That’s not going to go away altogether, but it is for sure going to be impacted.”
References:
- About DPPOS. https://dppos.bsc.gwu.edu/web/dppos/dppos. Accessed March 24, 2025.
- Closson T. Columbia agrees to Trump’s demands after federal funds are stripped. The New York Times. https://www.nytimes.com/2025/03/21/nyregion/columbia-response-trump-demands.html. Published March 21, 2025. Accessed March 24, 2025.
- Endocrine Society calls for restoration of Diabetes Prevention Program. https://www.endocrine.org/news-and-advocacy/news-room/2025/endocrine-society-calls-for-restoration-of-diabetes-prevention-program. Published March 19, 2025. Accessed March 24, 2025.
- Knowler WC, et al. N Engl J Med. 2002;doi:10.1056/NEJMoa012512.
- The American Diabetes Association’s statement on canceled Diabetes Prevention Program Outcomes study funding. https://diabetes.org/newsroom/press-releases/american-diabetes-association-statement-canceled-national-diabetes. Published March 18, 2025. Accessed March 24, 2025.
- Timeline for the National DPP – 1996 to 2016. https://coveragetoolkit.org/about-national-dpp/timeline. Published Dec. 6, 2024. Accessed March 25, 2025.
For more information:
David M. Nathan, MD, can be reached at dnathan@mgh.harvard.edu.
Richard E. Pratley, MD, can be reached at Richard.Pratley.MD@AdventHealth.com; X: @RpratleyMD
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