What are the pharmacotherapy options for treating prediabetes?

Abstract

INTRODUCTION:

The incidence of type 2 diabetes mellitus (T2DM) has risen to epidemic proportions, and this is associated with enormous cost. T2DM is preceded by 'prediabetes', and the diagnosis of impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) provides an opportunity for targeted intervention. Prediabetic subjects manifest both core defects characteristic of T2DM, that is, insulin resistance and β-cell dysfunction. Interventions which improve insulin sensitivity and/or preserve β-cell function are logical strategies to delay the conversion of IGT/IFG to T2DM or revert glucose tolerance to normal.

AREAS COVERED:

The authors examine pharmacologic agents that have proven to decrease the conversion of IGT to T2DM and represent potential treatment options in prediabetes.

EXPERT OPINION:

Weight loss improves whole body insulin sensitivity, preserves β-cell function and decreases progression of prediabetes to T2DM. In real life long-term weight loss is the exception and, even if successful, 40 - 50% of IGT individuals still progress to T2DM. Pharmacotherapy provides an alternative strategy to improve insulin sensitivity and preserve β-cell function. Thiazolidinediones (TZDs) are highly effective in T2DM prevention. Long-acting glucagon-like peptide-1 (GLP-1) analogs, because they augment β-cell function and promote weight loss, are effective in preventing IGT progression to T2DM. Metformin is considerably less effective than TZDs or GLP-1 analogs.

• Authors: Giuseppe Daniele, Muhammad Abdul-Ghani, Ralph A DeFronzo
• Journal: Expert opinion on pharmacotherapy (Expert Opin Pharmacother) Vol. 15 Issue 14 Pg. 2003-18 (Oct 2014) ISSN: 1744-7666 [Electronic] England
• PMID: 25139488 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Hypoglycemic Agents
• Thiazolidinediones
• Metformin

Topics

• Clinical Trials as Topic
• Diabetes Mellitus, Type 2 (prevention & control)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin Resistance
• Insulin-Secreting Cells (physiology)
• Life Style
• Metformin (therapeutic use)
• Prediabetic State (drug therapy, metabolism)
• Risk Assessment
• Thiazolidinediones (therapeutic use)
• Weight Loss