Treating early signs of diabetes risk may stave off the disease

People who have slightly elevated blood sugar and other early signs of risk for type 2 diabetes may avoid developing the full-blown disease if they start taking medications or make lifestyle changes that are usually used to treat diabetes, researchers say. 

The study team examined data on 422 adults in southern California with slightly elevated blood sugar and an intermediate or high risk for developing diabetes based on how well they make and use insulin. All of the patients were told to make lifestyle changes like modifying their diet and exercise habits; 141 people were also asked to take two types of diabetes drugs, and 81 patients were asked to take three types of diabetes drugs. 

After an average follow-up period of almost three years, the annual rate of transitioning to full diabetes was 4.1 per cent among people who received only lifestyle therapy, and 1.7 per cent in patients on two diabetes drugs, the study found. None of the patients on three diabetes drugs developed diabetes. 

“Our study demonstrates that a personalised preventive strategy based upon physiology combining lifestyle modification and targeted medications can be extremely effective in preventing progression to diabetes,” said lead study author Dr John Armato of the Providence Little Company of Mary Cardiometabolic Centre in Torrance, California. 

“It is always recommended that patients embrace regular exercise, targeted weight loss, limitation of alcohol intake and getting adequate sleep because, if implemented consistently and maintained, this may be all that is needed to restore ideal health,” Armato said by e-mail. 

The study findings also suggest that some patients may want to consider the targeted use of medications in addition to lifestyle changes, Armato added. 

About one in three US adults have slightly elevated blood sugar that is sometimes called “prediabetes” even though it is not high enough to warrant a diabetes diagnosis, researchers note in The Lancet Diabetes & Endocrinology. Roughly one in three of these people will progress to full-blown diabetes within five to seven years, they write. 

In addition to looking at current blood sugar, or glucose, levels, and a signature of long-term glucose levels known as HbA1C, the researchers added measures of risk for progressing to full diabetes based on how well insulin is working to help cells use glucose for energy, and how well insulin-producing cells in the pancreas are functioning. 

All of the patients in the study who were prescribed two medications were given metformin, an older generic diabetes drug that has long been a mainstay of treatment for this disease and another diabetes pill, pioglitazone. 

People taking three medications were given metformin and pioglitazone, as well as a newer injected diabetes drug in a family of medicines that includes exenatide and liraglutide. 

Compared to people who only received lifestyle therapy, patients who took metformin and pioglitazone were 71 per cent less likely to develop diabetes, the study found. 

Patients who took both of those drugs as well as medicines like exenatide or liraglutide were 92 per cent less likely to develop diabetes than those who only received lifestyle therapy. 

One limitation of the study is that people who were given only lifestyle therapy received this treatment because they refused to take medications, so the treatment groups were not random, which might influence the results, the authors note. 

It is also not clear from the study whether medications may have prevented diabetes from developing or helped to manage symptoms in people who did develop diabetes, they add. 

Still, the results add to evidence suggesting that some people without full-blown diabetes may benefit from efforts to lower their blood sugar, Dr Robert Rhyder of Sandwell and West Birmingham Hospitals NHS Trust City Hospital in the UK writes in an accompanying editorial. 

But not all patients with slightly elevated blood sugar need medication, or three different drugs, to achieve optimal blood sugar levels, Rhyder cautions. 

“Many would consider intervention with three pharmaceutical agents, one of which is an injectable, to be excessive in this population,” Rhyder writes. “However, the complications of type 2 diabetes can be devastating and anything that can be done to avoid diabetes and therefore its complications is worthy of consideration.”