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Individuals with blood glucose elevations below the diabetic thresholds may be described as having prediabetes or dysglycemia. The term includes both impaired fasting glucose (FPG 6.1–7 mmol/L) and impaired glucose tolerance (plasma glucose of 7.8–11 mmol/L 2 hours after a 75 g oral glucose load).

Metabolic syndrome is a common, multifeatured constellation of central obesity, hypertension, dyslipidemia, insulin resistance and glucose abnormalities. It carries a significant risk of diabetes and cardiovascular disease.47 , 48

Several large studies have examined nonpharmacologic and pharmacologic strategies aimed at preventing the onset of type 2 diabetes mellitus in high-risk individuals.

The Finnish Diabetes Prevention Study (DPS)49 and the Diabetes Prevention Program (DPP)50 showed that calorie restriction and reduced fat intake combined with supervised, moderately intense physical activity of about 150 minutes/week significantly reduced the relative risk of progression from prediabetes to diabetes by 58% at 4 years. In the DPS the incidence of diabetes was 11% in those randomized to the lifestyle intervention versus 23% in the control group; in the DPP the incidence of diabetes was 4.8%, 7.8% and 11% in those randomized to the lifestyle intervention, metformin and placebo, respectively. The weight loss associated with lifestyle interventions was about 5–6% of initial body weight in these studies.

The benefits of the lifestyle changes were maintained after the discontinuation of the active intervention in the DPS. The relative risk of diabetes remained 36% lower in those originally randomized to the lifestyle intervention compared with the control group after a further 3 years of follow-up (4.3% vs 7.4%).51

Metformin 850 mg twice daily reduced the relative risk of progression from prediabetes to diabetes by 31% versus placebo in the DPP. After a 1- to 2-week washout period, the risk of progression to diabetes remained 25% lower in those treated with metformin than placebo.52

Acarbose has also been evaluated in prevention trials.53 In STOP-NIDDM, acarbose 100 mg TID resulted in a 30% reduction of progression to diabetes at 14 months (32% vs 42% with placebo).54

TZDs also reduce the risk of progression from prediabetes to diabetes.56 , 58 , 59

The DREAM study evaluated the effects of rosiglitazone and ramipril on progression from prediabetes to type 2 diabetes.55 , 56 , 57 Rosiglitazone significantly reduced the risk of progression to diabetes or death by 60% over 3 years compared with placebo (11.6% vs 26%) in patients with prediabetes and no other cardiovascular risk factors. The benefit of rosiglitazone in preventing progression to diabetes was offset to some extent by a significantly higher incidence of heart failure relative to placebo (0.5% vs 0.1%).56 In contrast to the demonstrated benefit of rosiglitazone, ramipril did not prevent the progression from prediabetes to diabetes in the DREAM trial.57 The use of ramipril was, however, associated with higher rates of normalization of glucose tolerance and lower overall blood glucose levels.

The results of DREAM are consistent with 2 large prospective studies (TRIPOD58 and the DPP59) demonstrating that troglitazone, a TZD that is no longer available, delayed progression from prediabetes to diabetes.

There are no known safe and effective measures to prevent type 1 diabetes.

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