An Antidiabetic Drug to PREVENT Diabetes?

As our knowledge of diabetes and its complications has progressed, the concept of prediabetes has developed. People who are overweight and inactive are at risk of becoming diabetic, and prediabetes is a step on the way; if your fasting blood sugar is between 100 and 125 mg/dL, you have prediabetes, and are highly likely to develop diabetes at a future date. With determination, you can probably arrest this downhill progress by a turnaround in your lifestyle – correct nutrition, weight control or loss, and plenty of exercise.

A new alternative seems to have arisen. Taking rosiglitazone (Avandia®), a drug that reduces insulin resistance and maybe preserves insulin secretion, can reduce the likelihood of developing full-blown diabetes.

Canadian physicians reported in the medical journal Lancet on the results in 5,250 people with prediabetes (as defined above, or an impaired glucose tolerance test - blood sugar between 140 and 200 mg/dL 2 hours after a glucose drink). Half of them were given rosiglitazone (8 mg daily) and half placebo, for 3 years. During this time 12% of those given rosiglitazone developed diabetes or had died, compared with 26% in the placebo group. Over half of the rosiglitazone group and 30% of the placebo group dropped out of the prediabetes classification i.e. they had normal fasting blood sugar (below 100 mg dL). The only negative: 0.5% of rosiglitazone and 0.1% of the placebo patients developed heart failure, a difference that was statistically different.

Further analyses showed that the patients with the highest weight and waist girth at baseline were more likely to do well on rosiglitazone. But these are exactly the people who should be able to do well by energetic attack on their lifestyle, leading to weight loss. Although lifestyle advice was given in this study, it would be wrong to conclude that a pill is a substitute for sensible diet, exercise and weight management. Maybe I’m just being naïve, though.