Tuesday 8 June 2010

Prevention of Type 2 Diabetes

Prevention of Type 2 Diabetes

Several studies using therapeutic lifestyle changes and pharmacologic intervention have documented 'prevention' of Diabetes from the prediabetic state. as classified by recurrently changing diagnstic criteria established by various organizations. i.e American Diabetes Association. The truth of the matter is that many of these subjects have diabetes if the diagnostic criteria established prior to 1980 are used. Infact almost 1400 subjects in UKPDS were 'Prediabetes' according to the present diagnostic criteria and the progression of the disease was delayed by any of the three pharmacologic therapy used. In fact , the best outcome in this regard was achieved bu SUs in this study. e.g. Glycemic control lapsed after only 4 years with Metformin whereat it lapsed after 7 years following therapy with Chlorpropamide.Alternatively, 25 % of subjects treated with SU were HbA1c less than 76 % at 9 years whereas the numbers for Metformin were 13% and 11 % for conventional arm. The data thus suggest that early therapy with SU would provide a similar if not additional benefit as compared to intervention.s with Metformin. Moreover 'DREAM' trial clearly showed that benefit is lost and the delaying trend is reversed on discontinuing the intervention. Therefore, it is distinctly apparent that early treatment with antihyperglycemic drugs delays the progression of abnormal glucose metabolism and not 'prevent' the disease.Finally, in the similar context these intervention may delay 'progression to 'Prediabetes' from the state of normal glucose toelerance.Does this mean that every subject with predilection to develop Diabetes i.e Obese , extensive family history, high risk ethnic population etc should be a candidate fir pharmacologic intervention?

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