Blog | Tuesday, June 12, 2012

QD: News Every Day--Early, aggressive treatment of pre-diabetes is best


People with pre-diabetes who can normalize their blood sugars, even temporarily, are less likely to develop full-blown diabetes, a study found.

The conclusion led authors to suggest that early and aggressive treatment is the course to follow to treat diabetes, "a shift in the standard of care to early and aggressive glucose-lowering treatment in patients at highest risk," according to the study, which appeared online June 9 at The Lancet.

The study reported outcomes from an observational follow-up of 1,990 people who had been randomly assigned during a previous interventional trial (736 people to intensive lifestyle intervention, 647 to receive metformin, and 607 to receive placebo).

Diabetes risk was 56% lower for participants who had returned to normal glucose levels, defined as fasting plasma glucose lower than 5.6 mmol/L and 2 hour plasma glucose lower than 7.8 mmol/L, when compared to those who consistently had prediabetes, defined as fasting plasma glucose concentrations of 5.6 to 6.9 mmol/L or 2 hour plasma glucose of 7.8 to 11 mmol/L.

Variables associated with associated with normal glucose regulation included:
--previous achievement of normal glucose regulation (odds ratio [OR], 3.18; 95% CI, 2.71 to 3.72; P less than 0.0001),
--increased beta-cell function (OR, 1.28; 95% CI, 1.18 to 1.39; P less than 0.0001), and
--insulin sensitivity (OR, 1.16; 95% CI, 1.08 to 1.25; P less than 0.0001).

The opposite was true for prediction of diabetes, with increased beta-cell function (HR, 0.80; 95% CI, 0.71 to 0.89; P less than 0.0001) and insulin sensitivity (HR, 0.83; 95% CI, 0.74 to 0.94; P=0.0001) having a protective effect.

Among participants who did not return to normal glucose regulation in the original intervention trial, those assigned to the intensive lifestyle intervention had a higher diabetes risk (HR, 1.31; 95% CI, 1.03 to 1.68; P=0.0304) and lower chance of normal glucose regulation (OR, 0.59; 95% CI, 0.42 to 0.82; P=0.0014) than did the placebo group.

Patients with normal glucose regulation could have been more motivated for treatment, since they were long-term participants in two studies. The authors continued, "However, we should point out that a single determination of impaired glucose tolerance has been shown to predict increased diabetes risk three-times over 5.8 years, even after the return to normal glucose regulation in a high-risk population. Our study is the first to show that the converse is true for the attainment of normal glucose regulation in people with prediabetes."

The risk reduction approximates that seen with intensive lifestyle intervention but with a greater long-term effect, the authors continued. Risk reduction occurred regardless of treatment with lifestyle modification or metformin or placebo, suggesting that achievement of normal glucose regulation is more important than the method used to achieve it. And, the study population demographic closely resembled the U.S. population with prediabetes.