Prediabetics– people with impaired fasting glucose or impaired glucose tolerance– can reduce their high risk of progressing to diabetes if they achieve even a transient return to normal glucose regulation, according to results of the Diabetes Prevention Program Outcomes Study (DPPOS), presented at the American Diabetes Association meeting and published simultaneously online in the Lancet.
Leigh Perreault and colleagues in the Diabetes Prevention Program Research Group analyzed data from 1,990 participants who had been randomized in the original DPP study to either intensive lifestyle intervention, metformin, or placebo. The risk of developing diabetes was significantly lowered by 56% in the study subjects who at some point during the DPP study had normal glucose regulation compared with those who continued to have prediabetes (hazard ratio 0.44, CI 0.37–0.55, p<0.0001). Diabetes prevention was strongly correlated with the number of times subjects were found to have normal glucose regulation.
For diabetes prevention it didn’t matter to which treatment group people were assigned if they attained normal glucose regulation at some point. However, people randomized to intensive lifestyle intervention who remained consistently prediabetic were more likely to develop diabetes.
The investigators wrote that the results of their study suggest “that the strategy is unimportant as long as the intervention is early (when someone has prediabetes) and can restore normal glucose regulation, even if transiently. Further, maintenance of prediabetes despite the potent glucose-lowering effects of intensive lifestyle modification represents a high-risk state and might warrant additional preventive strategies.”
In an accompanying comment, Natalia Yakubovich and Hertzel Gerstein write that “identification of regression to normoglycemia could be an important way to stratify people into those at higher and lower risk of progression to diabetes. Such stratification could therefore identify individuals for whom additional treatment might be needed to prevent diabetes or to slow down disease progression.”
Here is the press release from the Lancet:
Aggressive glucose-lowering treatments aimed at achieving normal glucose levels in people with prediabetes achieve maximum reductions in progression to diabetes in the long-term
People with “prediabetes” (a high risk state for overt type 2 diabetes) who experience a period of normal glucose regulation are 56% less likely to develop diabetes 5•7 years later, according to a new research Article presented at the American Diabetes Association 72nd Scientific Sessions on Saturday 9 June, and published Online First in The Lancet. This is one of four Articles (all presented at the American Diabetes Association 72nd Scientific Sessions) and a Series of three papers that are part of a special Lancet theme issue on diabetes .
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.
Blood glucose concentrations that are higher than normal, but not quite as high as seen in diabetes, is known as prediabetes. In 2011, the Centers for Disease Control estimated that 79 million Americans – 35% of the population – have prediabetes. Every year, approximately 11% of people with prediabetes 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.
The research, conducted by the Diabetes Prevention Program Research Group in the USA, uses results from the Diabetes Prevention Program Outcomes Study (DPPOS), a long-term research programme which continues to examine long-term outcomes in patients who took part in the Diabetes Prevention Programme (DPP), a study of more than 3,000 patients, all of whom had prediabetes and were therefore at high risk of developing Type 2 diabetes .
While previous analyses of the DPP and DPPOS data have shown that lifestyle interventions and drug treatment can effectively reduce the progression to diabetes among those with prediabetes, the new analysis looks at those patients who not only did not progress to diabetes, but actually reverted to normal glucose function at some point during the study period. They found that these participants had a 56% reduction in progression to diabetes during the 5•7 year follow-up period in DPPOS regardless of how the reversion to normal glucose regulation was achieved and even when it was only transitory.
The results may have important implications for those planning diabetes reduction strategies. According to lead author Dr Leigh Perreault of the University of Colorado, USA: “Results from the present analysis would contend that the strategy is unimportant as long as the intervention is early (when someone has prediabetes) and can restore normal glucose regulation, even if transiently…This analysis draws attention to the significant long-term reduction in diabetes risk when someone with prediabetes returns to normal glucose regulation, supporting a shift in the standard of care to early and aggressive glucose-lowering treatment in patients at highest risk”.
Commenting on the paper, Dr Natalia Yakubovich of McMaster University, Canada, said: “…identification of regression to normal glucose regulation could be an important way to stratify people into those at higher and lower risk of progression to diabetes. Such stratification could therefore identify individuals for whom additional treatment might be needed to prevent diabetes or to slow down disease progression”.
However, Dr Yakubovich also pointed out that further work will be needed before the findings begin to inform diabetes prevention strategies, stating that: “Factors that predict regression to normal glucose regulation, what makes this regression temporary or sustained, and whether regression reduces long-term outcomes are all questions that need further research. The results of such research might substantially change the therapeutic strategy from diabetes prevention and lifelong glucose lowering treatment to induction of regression and monitoring for relapse”.