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A Pill to Prevent Diabetes?

Posted on January 23, 2018 | No Comments on A Pill to Prevent Diabetes?

What if your entire life could be compressed into a twelve-hour clock ; and you knew you would develop diabetes at the eleventh hour, would a you turn the hands of time before it o struck eleven? Wishful thinking? Perhaps. But in a way, it IS possible to reset the 3 clock of diabetes.

Lifestyle first
Robust proof that lifestyle intervention can reduce the risk of developing diabetes does exist. Regular moderately intense physical activity (e.g., brisk walking -30 minutes daily), weight reduction (at least 7 percent) for the overweight and a healthy diet (low in saturated fat, high in fiber) have significantly lowered the incidence of diabetes by about 58 percent. Lifestyle change, however, is difficult to sustain. Is there a magic pill that can make diabetes go away? Now, that is wishful thinking. Evidence seems promising though, and in fact, some pills have been shown to cut diabetes risk considerably.

Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are abnormalities in the body’s ability to handle blood sugar usually lumped under the term prediabetes. Prediabetes is a condition wherein blood sugar levels
are higher than normal but not high enough to be labeled diabetic. In 2003, about 314 million adults worldwide had IGT. This figure is expected to skyrocket to 472 million by 2025 – way beyond the projected number for type 2 diabetes (380 million). The highest number of people with IGT live in Southeast Asia where the IGT prevalence is more than double that of diabetes.

Up to half of individuals with IGT will develop type 2 diabetes within 10 years. These people are also at higher risk for heart disease. The risk further rises with the onset of diabetes. Therefore, early aggressive steps to reduce the chances of at-risk individuals from developing frank diabetes are mandatory.

The International Diabetes Federation (IDF), American Diabetes Association (ADA), and the American Association of Clinical Endocrinologists (AACE) have all recently published guidelines for the prevention of type 2 diabetes. These organizations agree that lifestyle modification should be tried first. However, if diet and exercise interventions are not sufficient, then drug therapy may be considered in conjunction with them.

Drugs second
What medications have been shown to cut diabetes risk?

Metformin
In the Diabetes Prevention Program (DPP), lifestyle change slashed the risk of diabetes in people with IFG and IGT by 58% while metformin did so by 31%. In the Indian Diabetes Prevention Program (IDPP) both lifestyle change and metformin notably reduced the incidence of diabetes in Asian Indians with IGT, but no added benefit was seen with combining them. Relative risk reduction was 28.5% with lifestyle intervention, 26.4% with metformin and 28.2% with both lifestyle intervention and metformin combined.

The ADA recommends no other drug for diabetes prevention besides metformin and only under certain conditions. It recommends considering metformin for those with IFG and IGT and any of the following to prevent diabetes: age less than 60, body mass index (BMI) 35 kg/m and above, firstdegree relatives with diabetes, high triglycerides, low HDL or good cholesterol level, high blood pressure or HbAlc level over 6%. The IDF recommends metformin at lower cutoffs for BMI (above 30 or 27 kg/m’ depending on ethnicity).

Metformin is best avoided in patients with advanced kidney, liver, lung and heart disease and other conditions that predispose to lactic acidosis (buildup of lactic acid in the blood).

Acarbose
The STOP-NIDDM (Study to Prevent Non-Insulin-Dependent Diabetes Mellitus) trial found acarbose lowered diabetes risk by 25% and even certain heart-related problems by 49%. However, the study was limited by the drop-out of 31 % of the subjects largely due to side effects such as stomach upset, bloating and flatulence. Nevertheless the OF supports using acarbose in those who can tolerate its side-effects “to reduce diabetes and, potentially, cardiovascular risk”.

Glitazones
Troglitazone was shown to cut diabetes risk by 55% in women with prior gestational diabetes (diabetes during pregnancy) in the TRIPOD (Troglitazone in the Prevention of Diabetes) study. However, this drug was withdrawn from the market due to links with liver toxicity. Women in this study were then switched to pioglitazone in the PIPOD (Pioglitazone in the Prevention of Diabetes) study which showed lower risks of diabetes with pioglitazone. The DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) trial also showed that rosiglitazone reduced the risk of diabetes in prediabetic subjects by 62% compared to placebo.

The benefits of using glitazones though need to be weighed against the risks of potential adverse effects such as weight gain, fluid retention, congestive heart failure and fractures.

Orlistat
The XENDOS (Xenical in the Prevention of Diabetes in Obese Subjects) showed that the antiobesity pill orlistat cut diabetes risk by 37% when added to lifestyle intervention in obese subjects with IGT. However the study is limited by the low completion rate in the orlistat arm (52%). Adverse effects of orlistat include diarrhea, belly pain, nausea and flatulence. Overall, whether or not one pops a pill to prevent diabetes needs to be discussed with a physician taking into consideration one’s health condition and the cost of the pill not just to the pocket but also to one’s body. Ultimately, no pill can replace the benefits of a healthy lifestyle; so, eat right and move more to chuck diabetes.

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