Restoration of normal glucose regulation may prevent diabetes

Those with pre-diabetes can avoid getting diabetes

People with pre-diabetes are significantly less likely to develop diabetes if their blood glucose levels are normalized in time, according to new research by the Colorado School of Public Health and the University of Colorado School of Medicine.

The study was recently published in The Lancet.

"The importance of this analysis is clear," said Leigh Perreault, MD, a researcher with the CU School of Medicine and the Colorado School of Public Health. "Physicians should seek to restore normal glucose regulation in their patients with pre-diabetes."

The study shows that those at a high risk for Type 2 diabetes who experience a period of normal glucose regulation are 56 percent less likely to develop the disease 10 years later.

In 2011, the Centers for Disease Control and Prevention estimated that 79 million Americans or 35 percent of the population have pre-diabetes. Every year, approximately 11 percent go on to develop the disease, fueling the epidemic of Type 2 diabetes. Re-thinking prevention strategies in this group is critical to reducing overall disease rates.

Perreault, an associate professor of medicine and public health, conducted the research along with colleagues in the Diabetes Prevention Program Research Group. They used findings from the Diabetes Prevention Program Outcomes Study (DPPOS), a research effort examining long term outcomes in patients who took part in the Diabetes Prevention Program (DPP). The DPP studied over 3,000 patients with pre-diabetes.

Earlier analyses of the DPP and DPPOS data showed that lifestyle interventions and drug treatment can reduce the progression of pre-diabetes to diabetes. But the new research examines patients who not only avoided developing diabetes, but actually reverted to normal glucose function at some point during the study period.

These participants experienced a 56% reduction in progression to diabetes, regardless of how they reverted to normal glucose regulation even when it was only transitory.

The implications are significant for those planning diabetes reduction strategies who might now want to shift the standard of care to early and aggressive glucose-lowering treatments in patients at highest risk of developing Type 2 diabetes.

"Interventions that simply maintain pre-diabetes, even where overt diabetes is avoided short-term, are not enough as the long-term risk remains," Perreault said. "Strategies and follow-up should focus on achieving normal glucose regulation, by whatever means and however transient, to ensure the greatest reduction in diabetes risk for those with pre-diabetes."