June 13, 2012
Tracy Breen, MD
A new study focusing on patients with pre-diabetes concentrates on aggressive glucose-lowering treatments to achieve normal glucose levels in people with pre-diabetes to achieve maximum reductions in progression to diabetes in the long-term. The study has some promising results. People with pre-diabetes (a high risk state for overt type 2 diabetes) who experience a period of normal glucose regulation are 56 percent less likely to develop diabetes 5∙7 years later, according to a research article presented at the American Diabetes Association’s 72nd Scientific Sessions presented earlier this month and published online in The Lancet.
The findings may have significant implications for diabetes prevention strategies, suggesting that early and aggressive glucose-lowering treatment in people at the highest risk of the disease could be an effective way of reducing progression to diabetes.
The study provides some guidance regarding how we can identify successful diabetes prevention efforts in individuals identified as having pre-diabetes. In the study, the actual strategy (medication prescription v.s. lifestyle modification) mattered less than whether the individual was able to achieve a normal glucose level. While these findings need to be studied further, they give some guidance to clinicians on how to potentially monitor the success of their pre-diabetes interventions. If a person remains "pre-diabetic" despite pharmacologic and/or lifestyle interventions the clinician may want to consider more intensive intervention as there seems to be a high likelihood that the individual will progress to overt diabetes.
Blood glucose concentrations that are higher than normal, but not as high as people identified as having diabetes, is known as pre-diabetes. In 2011, the Centers for Disease Control estimated that 79 million Americans – 35 percent of the population – have pre-diabetes. Every year, approximately 11 percent of people with pre-diabetes go on to acquire diabetes, singlehandedly fueling the epidemic of type 2 diabetes. Rethinking prevention strategies in this group is critical in order to reduce overall rates of the disease.