What are the pharmacotherapy options for treating prediabetes?. (October 2014)

• Record Type: Journal Article
• Authors: Daniele, Giuseppe; Abdul-Ghani, Muhammad; DeFronzo, Ralph A
• Is Part Of: Expert opinion on pharmacotherapy. Volume 15:Number 14(2014)
• Page Start: 2003
• Page End: 2018
• Publication Date: 2014-10
• Subjects: Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1517/14656566.2014.944160
• Languages: English
• ISSNs: 1465-6566

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <p> <bold> <italic>Introduction:</italic> </bold> 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.</p> <p> <bold> <italic>Areas covered:</italic> </bold> The authors examine pharmacologic agents that have proven to decrease the conversion of IGT to T2DM and represent potential treatment options in prediabetes.</p> <p> <bold> <italic>Expert opinion:</italic> </bold> 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.</p> </abstract>