Effects of metformin and intensive lifestyle interventions on the incidence of kidney disease in adults in the DPP/DPPOS

•What is already known about this subject?•Glycemic control is able to prevent/delay the onset and delay the progression of diabetic kidney disease.•What is the study question?•Do interventions that prevent or delay the onset of type 2 diabetes influence the development of later kidney disease?•What are the new findings?•Development of kidney disease was increased in subjects who developed diabetes in the DPPOS.•The development of kidney disease did not differ among treatment groups possibly due to their limited glycemic separation.•How might this impact on clinical practice in the foreseeable future?•Lifestyle and Metformin interventions reduce the development of diabetes in high-risk individuals.•These interventions may need to be given for many years before an effect on the long-term complications of diabetes is seen.