Glucose-lowering regulations in people with prediabetes achieves reduction 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 72^nd 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 72^nd Scientific Sessions) and a Series of three papers that are part of a special Lancet theme issue on diabetes [1].

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 [2].

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”.