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Are There Medicines that prevent Diabetes?

Eating well, incorporating regular physical activity into your daily routine and maintaining proper weight are still all key to preventing type 2 diabetes. This is particularly important in people already with risk factors — like being overweight, having close relatives with diabetes, having had diabetes during a previous pregnancy or if one already has prediabetes (a condition wherein blood sugar levels are higher than normal but not high enough for a diagnosis of diabetes). But because some people would rather take a pill than go to the gym, researchers have looked at certain medications and their efficacy on diabetes prevention.

Two large studies, the Diabetes Prevention Program (DPP) in the US and the Finnish Diabetes Prevention Study, showed that nothing beats diet and intensive exercise in delaying the progression to diabetes. Certain medications do have an effect in postponing the onset of diabetes and these include anti-diabetic drugs (acarbose, metformin, rosiglitazone and pioglitazone) and a weight loss medication (orlistat).

After each meal, our stomach and intestines produce enzymes that break starchy foods down so they can easily be absorbed. Alpha-glucosidase inhibitors, like acarbose, slows down these enzymes and delays the absorption of carbohydrates thereby lowering the blood sugar after a meal. These medicines are taken with the first bite of the meal for better efficacy. The more common side effects are gassiness, bloating and sometimes diarrhea.

People with impaired glucose tolerance (IGT) have normal fasting blood sugars but their blood sugars after eating are higher than normal-they have prediabetes. In one study, overweight people with IGT treated with acarbose were less likely to have diabetes after 3.3 years compared to those people not taking any medication. By lowering the blood sugar after meals, taking acarbose 100 mg three times a day essentially prevented diabetes in these patients. Some patients with IGT may benefit from acarbose treatment along with dietary changes, exercise and weight loss.

Metformin is one of the first-line treatments for diabetes. It acts by reducing the release of glucose from the liver and lowering the fasting blood sugars in the morning. It also makes whatever insulin is left in the pancreas work more effectively to bring down the blood sugars. It has an added advantage of helping patients achieve weight loss especially if combined with diet and exercise.

When used in DPP participants, metformin was shown to delay the diagnosis of diabetes. The effect was more remarkable in both men and women aged 25 to 44 years and those who were obese with a body mass index (BMI) of >35. The common side effects are stomach discomfort, vomiting and diarrhea. These can be prevented by starting at lower doses and increasing gradually. Metformin cannot be given to patients with kidney problems or to those with excessive alcohol intake. As is true for all medications, you should first check with your doctor if you will benefit from this treatment.

Thiazolidinediones (TZDs or the “glitazones” are diabetes medications that act by making insulin action more effective or by reducing insulin resistance. The 2 drugs in this class include rosiglitazone and pioglitazone. A large diabetes prevention trial looked at the effect of rosiglitazone in prediabetic people over 3 years. These included people with IFG (those with FBS between 100- 125mg/d1), IGT or both IFG/IGT. The study showed that rosiglitazone reduced the risk for developing diabetes compared to those not taking any medication.

Gestational diabetes (GDM) is diabetes diagnosed during pregnancy. Most of these women have normal blood sugars after they give birth. However, women with GDM are more likely to develop diabetes later in life. Pioglitazone was shown to lower the yearly incidence rate of developing diabetes in these women. The common side effects of TZDs are water retention and weight gain. These drugs cannot be given to patients with liver and heart problems. Be sure to check with your doctor before taking these medications.

Orlistat is a weight-loss medication that works by decreasing the amount of fat that is absorbed from our diet. Obesity is one of the more common risk factors associated with developing type 2 diabetes. And it is also the most modifiable – meaning, if we can lose weight, we can lower our risk for becoming diabetic. It has been shown that when orlistat is given to obese persons, in addition to losing weight, they were also less likely to become diabetic after the 4 year observation period. This was in comparison to those on diet and exercise alone. The common side effects are oily stool, bloating and diarrhea. Lowering the amount of fat in the diet helps in reducing these side effects. Overweight and obese people may benefit from taking orlistat in combination with a healthy, low fat diet.

Bottom Line
The bottom line is that there are medications out there that may delay the progression to developing diabetes. But remember that lifestyle modification trumps all of them. Before taking any medication, please talk to your doctor in detail about the achievable benefits and possible risks that these may have on you.

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