[Should type 2 diabetes prevention pharmacological studies prompt us to change our prescription habits?].
Type 2 diabetes (T2D), a major public health problem in all parts of the world, is preceded by an identifiable phase of impaired glucose tolerance (IGT) during which a therapeutic intervention aimed at preventing the glycaemic decompensation can be considered. The efficacy of a diet resulting in a weight loss and even more of an exercise program has been clearly established, but the long term continuation of these measures is difficult in real life conditions. So, pharmacological interventions on insulin resistance and B cell dysfunction, the major pathophysiologic components of the disease have been tested. A relative risk reduction of conversion from IG to T2D has been obtained with metformin in the Diabetes Prevention Program, but this effect seems to be directly linked to the antihyperglycaemic effect of the drug. Likewise, the relative risk reduction of 25% with acarbose in the Stop-NIDDM trial results more from a short term therapeutic effect than from an action in depth on the mechanisms leading to the glycaemic decompensation. This might does not be the case with troglitazone in the TRIPOD trial, since the protection conferred by this drug largely exceeds the treatment period and the B cell function appears to be preserved. However, these results should be confirmed in larger and more common populations of IGT. Finally, the practical carrying out of a prevention program at the scale of a whole population raises several unsolved problems.
Blicklé
J F
JF
Service de Médecine Interne, Diabétologie et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. Jean-Frederic.Bickle@chru.strasbg.fr
D002839:Chromans / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005602:France; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D045162:Thiazolidinediones / Q000627:therapeutic use; D000077288:Troglitazone
D002839:Chromans; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077288:Troglitazone