A drug widely used to treat Type 2 diabetes delayed or prevented progression of pre-diabetes to diabetes by more than 60 percent in the largest prevention trial ever conducted, researchers reported yesterday.
More than 41 million Americans have blood glucose abnormalities -- known as pre-diabetes -- that indicate that they might soon develop diabetes, making them good candidates for use of the drug, called rosiglitazone.
There is no treatment but diet and exercise for preventing progression to Type 2 diabetes.
"I think it will change treatment practices if it stands up," said Dr. Andrew Drexler, director of UCLA's Gonda Diabetes Center. He was not involved in the study.
Some physicians, such as Dr. Stuart Weiss of the New York University School of Medicine, have begun giving rosiglitazone to their pre-diabetic patients.
"Getting people on drugs early is a very important thing," he said. The complications of diabetes, such as heart and kidney disease, "occur even before the diabetes is diagnosed. We need to be much more aggressive and get in sooner."
The one important side effect of the drug during the three-year study was an increase in congestive heart failure, although the absolute number of cases was low and physicians were able to manage it successfully.
The results with rosiglitazone, which costs as much as $170 per month, are comparable to those achieved with intensive programs to modify diet and increase exercise.
The results of the study were presented yesterday in Copenhagen to the European Association for the Study of Diabetes. They will be published in today's issue of the journal Lancet.
In the United States, an estimated 18 million people have Type 2 diabetes, and the number has been growing so rapidly that the Centers for Disease Control and Prevention has declared diabetes an epidemic. Worldwide, 220 million people have diabetes; most of them later develop heart disease, kidney disease, blindness or nerve damage, often leading to amputation of limbs.
"Anything we can do to prevent it will have huge public health implications," said Dr. Vivian Fonseca of the Tulane University Health Sciences Center.
Unlike Type 1 diabetes, in which the pancreas stops producing insulin completely, Type 2 diabetes occurs when the pancreas loses part of its ability to produce insulin and the body's cells lose part or all of their ability to use insulin to remove glucose from the bloodstream for use by cells.
