Diabetes Could Be Reduced With Aggressive Treatment Of Pre-Diabetes, Study

Date: Jun-11-2012Treating pre-diabetes early and aggressively with intensive lifestyle changes or medication could be an effective way to significantly reduce the chances
of developing type 2 diabetes later.

This was the implication of a new study reported online first in The Lancet on Saturday that shows even when people with pre-diabetes achieved a
temporary return to normal glucose levels, they were 56% less likely to develop type 2 diabetes 5.7 years later.

The Diabetes Prevention Program Outcomes Study (DPPOS) report is part of a Lancet theme issue on diabetes. Several of the papers were also
presented at the American Diabetes Association 72nd Scientific Sessions, which is taking place at Philadelphia in the US between 8 and 12 June.

Pre-diabetes is considered a "high risk state" for overt type 2 diabetes. In pre-diabetes, blood glucose levels are higher than normal, but not as high as in
diabetes.

The US Centers for Disease Control and Prevention (CDC) estimate that 79 million Americans, over a third of the adult population, have pre-diabetes. About one in
ten people with pre-diabetes goes on to develop full blown diabetes. Thus finding new ways to successfully reduce pre-diabetes could slow the growth of the
diabetes epidemic.

The DPPOS is a long term research programme that is continuing to monitor 3,000 patients that took part in the Diabetes Prevention Programme (DPP) in the US. All the
patients had pre-diabetes and were therefore at high risk of developing type 2 diabetes.

In this analysis, the data covered patients randomized to one of three groups: 736 to intensive lifestyle intervention, 647 to the pre-diabetes drug metformin,
and 607 to placebo.

Previous analysis of the data had already shown that changes to lifestyle and medication can effectively reduce the chance of pre-diabetes progressing to full
blown disease.

But this latest study analyzed the data a step further: it looked at those patients who not only did not progress to diabetes, but whose glucose levels actually
returned to normal at some point during the period they were being followed.

The results showed that those patients had a 56% reduction in progression to diabetes during 5.7 years of follow up. This was regardless of what caused the
return to normal glucose, and the reduction was the same even when the return was only temporary.

They also showed that the intensive lifestyle intervention patients whose glucose levels never returned to normal were the ones most likely to develop diabetes,
compared to the controls.

The authors conclude that:

"... prediabetes is a high-risk state for diabetes, especially in patients who remain with prediabetes despite intensive lifestyle intervention. Reversion to normal
glucose regulation, even if transient, is associated with a significantly reduced risk of future diabetes independent of previous treatment group."

The findings have important implications for policymakers and those who plan strategies for reducing diabetes. Lead author Dr Leigh Perreault of the University
of Colorado Anschutz Medical Campus in the US, told the press:

"This analysis draws attention to the significant long-term reduction in diabetes risk when someone with prediabetes returns to normal glucose regulation,
supporting a shift in the standard of care to early and aggressive glucose-lowering treatment in patients at highest risk."

In a Comment article in the same issue of the journal, Dr Natalia Yakubovich of McMaster University, Canada, writes:

"... identification of regression to normal glucose regulation could be an important way to stratify people into those at higher and lower risk of progression to
diabetes. Such stratification could therefore identify individuals for whom additional treatment might be needed to prevent diabetes or to slow down disease
progression."

But, Yakubovich also notes that these findings on their own are not enough, more work would be needed to cause a revision of diabetes prevention
strategies:

"Factors that predict regression to normal glucose regulation, what makes this regression temporary or sustained, and whether regression reduces long-term
outcomes are all questions that need further research."

However:

"The results of such research might substantially change the therapeutic strategy from diabetes prevention and lifelong glucose lowering treatment to induction
of regression and monitoring for relapse," she added.

Written by Catharine Paddock PhD

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