title: What are the pharmacotherapy options for treating prediabetes?
abstract: BACKGROUND
  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.
  
  
  METHODS
  The authors examine pharmacologic agents that have proven to decrease the conversion of IGT to T2DM and represent potential treatment options in prediabetes.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Texas Health Science Center at San Antonio, Division of Diabetes , 7703 Floyd Curve Dr, San Antonio, TX, 78229 , USA +1 210 567 6691 ; +1 210 567 6554 ; albarado@uthscsa.edu.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Daniele
authors.forename: Muhammad
authors.initials: M
authors.lastname: Abdul-Ghani
authors.forename: Ralph A
authors.initials: RA
authors.lastname: DeFronzo
mesh_terms: D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000502:physiology; D008019:Life Style; D008687:Metformin / Q000627:therapeutic use; D011236:Prediabetic State / Q000188:drug therapy* / Q000378:metabolism; D018570:Risk Assessment; D045162:Thiazolidinediones / Q000627:therapeutic use; D015431:Weight Loss
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D008687:Metformin
keywords: glucagon-like peptide-1 analogs; pharmacotherapy; prediabetes; weight loss