The STOP-NIDDM Trial: an international study on the efficacy of an alpha-glucosidase inhibitor to prevent type 2 diabetes in a population with impaired glucose tolerance: rationale, design, and preliminary screening data. Study to Prevent Non-Insulin-Dependent Diabetes Mellitus.
OBJECTIVE
To describe the rationale and design, and to discuss the preliminary screening data, of the Study to Prevent NIDDM (STOP-NIDDM Trial), an international study on the efficacy of the alpha-glucosidase inhibitor acarbose in preventing or delaying the development of type 2 diabetes in a population with impaired glucose tolerance (IGT).


METHODS
A total of 1,418 subjects diagnosed with IGT according to the World Health Organization's criteria and having a fasting plasma glucose concentration > or =5.6 mmol/L were randomized in a double-blind fashion to receive either acarbose (100 mg t.i.d.) or placebo for a predictive median follow-up period of 3.9 years. The primary outcome is the development of type 2 diabetes diagnosed using a 75-g oral glucose tolerance test according to the new criteria. The secondary outcomes are changes in blood pressure, lipid profile, insulin sensitivity, cardiovascular events, and morphometric profile.


RESULTS
Screening was performed in a high-risk population. As of 1 March 1997, 4,424 subjects had been screened, and data were available for 3,919 (88.5%) subjects. Of these subjects, 1,200 (30.6%) had glucose intolerance. Of the subjects with glucose intolerance, 521 (13.3%) had previously undetected type 2 diabetes, and 679 (17.3%) had IGT. Of the IGT population, 412 (60.7%) subjects were eligible for the study This population had the following characteristics: the mean age was 54.8 years, 52% of the subjects were female, 53% had more than one risk factor for type 2 diabetes, >90% had a family history of diabetes, 78.2% had a BMI > or =27 kg/m2, 47.5% had high blood pressure, 51.2% had dyslipidemia, and 22.8% of the women had a history of gestational diabetes.


CONCLUSIONS
Screening of a high-risk population yields one eligible subject per every 10 volunteers screened. This study should definitely answer the question of whether acarbose can prevent or delay the progression of IGT to type 2 diabetes mellitus.
Centre Hospitalier de L'Université de Montréal, Department of Medicine, University of Montreal, Quebec, Canada. chiassoj@ere.umontreal.ca
J L
JL
Chiasson
R
R
Gomis
M
M
Hanefeld
R G
RG
Josse
A
A
Karasik
M
M
Laakso
D020909:Acarbose; D001794:Blood Pressure; D002170:Canada; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002985:Clinical Protocols; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D016640:Diabetes, Gestational / Q000453:epidemiology; D004311:Double-Blind Method; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D005951:Glucose Tolerance Test; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007391:International Cooperation; D007557:Israel; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011247:Pregnancy; D012107:Research Design; D012307:Risk Factors; D013997:Time Factors; D014312:Trisaccharides / Q000627:therapeutic use*
D007004:Hypoglycemic Agents; D014312:Trisaccharides; D020909:Acarbose