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Drugs commonly used to treat type 2 diabetes do not prevent prediabetes from becoming a complete form of the disease, suggests a major new study. The study, published in June 2019 in Diabetic treatments and presented at the 79th Scientific Session of the American Diabetes Association (ADA) in San Francisco, means that physicians who are trying to help people with prediabetes permanently avoid type 2 diabetes need to get back on track. reflection.
The drug Glucophage (metformin), as well as diet and exercise programs, are effective measures of diabetes prevention, according to the National Institute of Diabetes and Digestive and Kidney Diseases. But the strategies tested in the new study, which included more potent drugs usually reserved for people with type 2 diabetes, did not help prediabetics after treatment was discontinued.
"We see benefits, as expected. But the question is: can we sustain the results and the answer is that we could not, "says study author, Kieren J. Mather, MD, professor of medicine in the Division of Endocrinology and metabolism, and badociate director of the Center for Translational Diabetes Research at the Indiana School of Medicine in Indianapolis.
According to the National Institutes of Health, about 84 million Americans have prediabetes. These people are at risk of developing type 2 diabetes. The Diabetes Prevention Program (DPP), a public-private partnership to help people at risk of type 2 diabetes to avoid developing the disease, is a source of support. for people at high risk. The program includes a toolbox of effective strategies, such as losing weight, following a healthy diet, and exercising.
"We identify a group of people at risk and try to find something to do that preserves beta cells and prevents them from progressing," says Dr. Mather. "What can we offer that can make a difference? "
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After 12 months of using the drug and 3 months off, the benefits disappear
The study, Restoring Insulin Secretion (RISE), was designed to examine whether beta cells could recover and function normally after people with prediabetes have been treated for a limited time with antidiabetic drugs. Beta cells are pancreatic cells that produce, store and release insulin, a hormone, according to Diabetes UK.
The researchers badigned adults with prediabetes or early type 2 diabetes to one of four treatment regimens: placebo pills; metformin alone; long-acting insulin therapy known as Lantus (insulin glargine) followed by metformin; or the drug Victoza (liraglutide), a glucagon-like peptide-1 receptor agonist (GLP-1), plus metformin, according to the details of the study. Health care providers generally do not prescribe glargine and Victoza for people who have not yet developed type 2 diabetes.
"Everyone received lifestyle recommendations because we were leaving the diabetes prevention program," said Mather.
Researchers followed participants for 12 months of active treatment and then rebadessed them three months after stopping treatment. The researchers looked at glucose tolerance during treatment and after withdrawal from treatment to determine if any of the treatment regimens resulted in a lasting benefit, such as beta cell recovery or decreased glucose levels. They found that people taking Victoza had the most important benefits during treatment, followed by modest effects of metformin and insulin glargine. Three months after stopping the drugs, none of the subjects showed lasting benefit.
"At 15 months, everything is gone," says Mather. "We have not been able to induce lasting change."
Diabetes is a progressive disorder in which beta cells deteriorate. The study tested the idea that cells could recover early in the course of the disease, says Alvin C. Powers, MD, professor of endocrinology at the Faculty of Medicine at the University of Toronto. Vanderbilt University of Nashville, Tennessee. Dr. Powers did not participate in the study.
"The people studied in this field were very early in the disease. There is this idea that if you rest insulin cells, they would work better and you could delay or eventually stop any progression of the disease, "he says. "It was a well-done study designed to determine whether you were changing natural history or not. I think that means that these specific drugs that have been used can not alter the natural history of the disease. "
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A similar study, published in August 2018 in Diabetic treatments, in children and adolescents with impaired glucose tolerance or newly diagnosed type 2 diabetes, found that three months of glargine followed by nine months of metformin and 12 months of metformin alone did not stop progression of diabetes. This study suggests that stopping the progression of diabetes in children and adolescents is particularly difficult.
"For kids, [the RISE Pediatric Medication Study] has been a remarkable information for the world. This tells us that children's illness is different and more aggressive. People have to watch what they are going to do for the kids, "said Mather.
As with adults with prediabetes, changing the diet and lifestyle is as effective as metformin, notes an article published in March 2017 in the US. Journal of the American Medical Association. But the RISE study does not support the use of more potent drugs, such as insulin or a glucagon-like peptide-1 receptor agonist, in people with prediabetes or very early diabetes.
Victoza is an injection, he notes, and should be continued indefinitely on the basis of the results of the RISE study.
"For the rest of your life, should you take this medicine? It's a tough hill to climb, "says Mather about people with prediabetes or early diabetes. "I do not know how easy it will be, and that may not be the right strategy. If you can do something aggressive for a short time, it is more acceptable. But being aggressive for a long time is not as acceptable. "
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