SATURDAY, June 9 (HealthDay News) -- Treating prediabetes
aggressively with lifestyle changes and medications may prevent its
progression to diabetes, a new study finds.
People with prediabetes who had their blood sugar returned to
normal were 56 percent less likely to develop full diabetes in the
five years after treatment, researchers say.
Prediabetes is a condition where blood sugar levels are higher
than normal, but not as high as seen in full-blown diabetes.
"The biggest risk for people with prediabetes is that about 70
percent of them will develop type 2 diabetes over their lifetime,"
said lead researcher Dr. Leigh Perreault, an associate professor of
medicine at the University of Colorado-Denver.
"This is singlehandedly fueling the diabetes epidemic," she
added.
According to the U.S. Centers for Disease Control and
Prevention, an estimated 79 million Americans -- about 35 percent
of the adult population -- have prediabetes. In addition, about 11
percent of these people go on to develop full diabetes each year,
the agency notes.
The report by Perreault and colleagues was published in the June
9 online edition of
The Lancet to coincide with the planned Saturday presentation
of the study findings at an American Diabetes Association meeting,
in Philadelphia.
For their study, Perreault's team used data from the Diabetes
Prevention Program Outcomes Study, which included more than 3,000
patients with prediabetes and was funded by the U.S National
Institutes of Health.
People in that trial were randomly assigned to one of three
groups: one group was asked to make lifestyle changes; a second
group was given the drug metformin, which lowers blood sugar; and
the third group was given an inactive placebo. The goal of the
program was for participants to reduce their blood sugar levels to
a normal range.
The new study looked at these individuals years later to see if
the gains they made during the trial were maintained.
The researchers found that patients who were able to return to
normal blood sugar levels, even for a short period, could prevent
or slow progression to full type 2 diabetes.
People who reduced their blood sugar had a 56 percent reduction
in progression to diabetes during nearly six years of follow-up
regardless of how those normal blood sugar levels were achieved and
even when it was only for a short time, the researchers found.
It didn't matter how people got back to normal, whether with
diet and exercise or with metformin or placebo, Perreault said. As
long as they went back to normal they had the benefit, she
noted.
Dr. Natalia Yakubovich, an assistant professor at McMaster
University in Hamilton, Ontario, and co-author of an accompanying
journal editorial, said that "if these findings are confirmed in
other studies, an ability to regress to normal glucose regulation
can help identify people at lower risk of developing diabetes,
while those people who do not regress despite conventional
therapies might need to be treated more aggressively to prevent
diabetes."
However, she added, "whether the regression improves other
long-term health care outcomes such as heart disease, kidney
disease or blindness is currently unknown and needs further
study."
Another expert, Dr. Joel Zonszein, a professor of clinical
medicine at Albert Einstein College of Medicine and a physician at
the Clinical Diabetes Center at Montefiore Medical Center, both in
New York City, added that "the analysis stresses the significant
long-term reduction in diabetes risk when someone with prediabetes
returns to [normal blood-sugar levels], supporting a shift in the
standard of care to early and aggressive glucose-lowering treatment
in patients at highest risk.
"My recommendation for my patients with early diabetes is
therapeutic lifestyle changes plus aggressive anti-diabetic agents
[often in combination]," he said.
This study supports the idea that early and aggressive
glucose-lowering not only prevents complications, but also may
preserve insulin function, thus requiring fewer medications later,
Zonszein said.
Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in
New York City, noted that it is currently the standard of care to
treat prediabetes with lifestyle changes and in some cases
metformin.
"Early control and regression to normal glucose levels does
confer benefit," she said.
Medicare and private insurance typically provide coverage for
blood sugar testing and for medications.
More information
For more about
prediabetes, visit the American Diabetes
Association.