title: Pharmacological interventions for preventing or delaying onset of type 2 diabetes mellitus.
abstract: Prevention or delay of onset of type 2 diabetes in individuals at varying risk across the dysglycaemia continuum before overt diabetes becomes clinically manifest constitutes a leading objective of global disease prevention schemes. Pharmacological intervention has been suggested as a means to help prevent diabetes and reduce the global burden of this chronic condition. However, there is no credible evidence that early pharmacological intervention leads to long-term benefit in reducing diabetes-related complications or preventing early mortality, compared to treating people with diagnosed diabetes who have crossed the glycaemic threshold. In this review, we examine published evidence from trials using pharmacological agents to delay or prevent progression to diabetes. We also explore the benefit/risk impact of such therapies, safety issues and relevant off-target effects. Current evidence suggests none of the drugs currently available sustainably lower cumulative diabetes incidence, none provides a durable delay in diabetes diagnosis and none provides a convincing concomitant excess benefit for microvascular or macrovascular risk.
authors.affiliation: Diabetes Trials Unit, University of Oxford, Churchill Hospital, Oxford, UK; Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Bethel
authors.forename: W
authors.initials: W
authors.lastname: Xu
authors.forename: M J
authors.initials: MJ
authors.lastname: Theodorakis
mesh_terms: D000328:Adult; D018890:Chemoprevention; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D018450:Disease Progression; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment
chemical_list: D007004:Hypoglycemic Agents
keywords: antidiabetic drug; clinical trial; type 2 diabetes