People with prediabetes, a high risk for overt T2DM, who experienced a period of normal glucose regulations are 56% less likely to develop diabetes 5-7 years later, according to a new research Article presented at the ADA on June 9, and published first 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 diabetes could be an effective way of reducing progression to diabetes.

In US around 79 million Americans have prediabetes, 35% of the population. Every year 11% of people with prediabetes convert to acquire T2DM, fueling the epidemic of T2DM in US. 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 US, 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 hade prediabetes and were therefore at high risk of developing T2DM.

While previous analysis of the DPP and DPPOS data have shown that lifestyle intervention and drug metformin can effectively reduce the progression to T2DM among those with prediabetes with NNT Numbers Needed to Treat 7 for lifestyle and 14 for metformin, the new analysis look at those patients who not only did not progress to diabetes, but actually reverted to normal glucose function during the study period.

They found that these participants had a 56% reduction in progression to diabetes during 5-7 years follow-up period in the 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 palnning diabetes strategies. According to lead author Leigh Perreault at the Univ of Colorado, US; Results from the present analysis could content that the strategy is unimportant as long as the intervention is ealry when someone has prediabeets and can restore normal glucose regulation, even if transiently.

The 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 the highest risk.

The full Article and Comment see

www.thelancet.com/journals/article/PIISO140-6736(12)60525-X/abstract

Or for the article theme issue

1) Effectiveness of quality improvement strategies on the managing of diabetes; a systematic review and meta-anlysis
http://press.thelancet.com/diabetesQ1.pdf

2) Insulin glargine versus sitagliptin in insulin-naive patients with type 2 diabetes mellitus uncontrolled on metformin (EASIE): a multicentre open-label trial
http://press.thelancet.com/glargine.pdf

3) Exenatide twice daily versus glimeperide for prevention of glycaemic detoriation with type 2 diabetes with metformin failure (EUREX): an opel-label, randomised controlled trial

http://press.thelancet.com/exenatide.pdf

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