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Experts make first comprehensive treatment recommendations for patients with prediabetes
Wednesday, August 06 2008 | Comments
What's This?
The American Association of Clinical Endocrinologists and the American College of Endocrinology issued a consensus statement outlining recommendations for the treatment of prediabetes that stress the role of lifestyle changes in halting the progression to overt diabetes and the development of cardiovascular complications.The recommended lifestyle changes are based on those outlined in the Diabetes Prevention Program (DPP), a randomized controlled trial involving 27 clinical centers in the United States. Results of the trial were published in The New England Journal of Medicine (2002;346:393-403).
In the DPP trial, participants were randomized to receive placebo, metformin, or a lifestyle intervention that involved intensive training in diet, exercise, and behavior modification. By reducing caloric and dietary fat intake and exercising 150 minutes each week, the lifestyle intervention participants strived to lose 7% of their body weight and to maintain the loss. Individuals in the lifestyle intervention group reduced their risk of incident diabetes by 58% relative to placebo, and data suggested that this intervention was significantly more effective than metformin (reduced risk of 31% relative to placebo).
Although lifestyle modifications were recommended as first-line therapy, the groups acknowledged that drug therapy might be warranted--particularly among high-risk patients--when lifestyle modifications are insufficient to control glucose levels.
Treatment of prediabetes should also focus on preventing the development of cardiovascular complications, the AACE and ACE added, with medications to control blood pressure and cholesterol when lifestyle interventions are not enough.
"The data show that there is a spectrum of severity, with the most severely affected approaching the risks of people with diagnosed type 2 diabetes," said Dr. Daniel Einhorn, vice president of the AACE. "In these highest risk individuals, who represent a minority, pharmacologic strategies may be appropriate if intensive lifestyle therapies fail."
The final guideline document will be published later this year in the journal Endocrine Practice.
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