Type 2 diabetes can be prevented with early pharmacological intervention

Ralph A Defronzo, Muhammad A Abdul-ghani

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

In the U.S., ∼21 × 106 individuals have type 2 diabetes, and twice as many have impaired glucose tolerance (IGT). Approximately 40-50% of individuals with IGT will progress to type 2 diabetes over their lifetime. Therefore, treatment of high-risk individuals with IGT to prevent type 2 diabetes has important medical, economic, social, and human implications. Weight loss, although effective in reducing the conversion of IGT to type 2 diabetes, is difficult to achieve and maintain. Moreover, 40-50% of IGT subjects progress to type 2 diabetes despite successful weight reduction. In contrast, pharmacological treatment of IGT with oral antidiabetic agents that improve insulin sensitivity and preserve β-cell function - the characteristic pathophysiological abnormalities present in IGT and type 2 diabetes - uniformly have been shown to prevent progression of IGT to type 2 diabetes. The most consistent results have been observed with the thiazolidinediones (Troglitazone in the Prevention of Diabetes [TRIPOD], Pioglitazone in the Prevention of Diabetes [PIPOD], Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication [DREAM], and Actos Now for the Prevention of Diabetes [ACT NOW]), with a 50-70% reduction in IGT conversion to diabetes. Metformin in the U.S. Diabetes Prevention Program (DPP) reduced the development of type 2 diabetes by 31% and has been recommended by the American Diabetes Association (ADA) for treating high-risk individuals with IGT. The glucagon-like peptide-1 analogs, which augment insulin secretion, preserve β-cell function, and promote weight loss, also would be expected to be efficacious in preventing the progression of IGT to type 2 diabetes. Because individuals in the upper tertile of IGT are maximally/near-maximally insulin resistant, have lost 70-80% of their β-cell function, and have an ∼10% incidence of diabetic retinopathy, pharmacological intervention, in combination with diet plus exercise, should be instituted.

Original languageEnglish (US)
JournalDiabetes Care
Volume34
Issue numberSUPPL. 2
DOIs
StatePublished - May 2011

Fingerprint

Glucose Intolerance
Type 2 Diabetes Mellitus
Pharmacology
pioglitazone
Weight Loss
rosiglitazone
troglitazone
Insulin
Ramipril
Medical Economics
Thiazolidinediones
Glucagon-Like Peptide 1
Metformin
Diabetic Retinopathy
Hypoglycemic Agents
Insulin Resistance

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Type 2 diabetes can be prevented with early pharmacological intervention. / Defronzo, Ralph A; Abdul-ghani, Muhammad A.

In: Diabetes Care, Vol. 34, No. SUPPL. 2, 05.2011.

Research output: Contribution to journalArticle

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