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Pre-diabetes treatment needed

12th June 2012

Researchers in the United States say a more aggressive approach to treating people who have pre-diabetes could actually reduce cases of fully developed type 2 diabetes.

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The study, published in The Lancet, showed that people with blood-sugar levels just below levels that indicate diabetes would benefit from early intervention.

It found that if such people's blood sugar returned to normal, even temporarily, during this period, their chances of going on to develop full diabetes were lessened by around 50%.

Experts have welcomed the findings as "clinically important".

Around 79 million people in the US and seven million in the UK are believed have blood-sugar levels in the pre-diabetes range, putting them at higher risk of getting type 2 diabetes, but also of experiencing a stroke or a heart attack.

Pre-diabetes can be reversed through increased exercise and weight loss, according to the study, which was carried out by the US Diabetes Prevention Programme Research Group.

For the purposes of the six-year study, researchers tracked the progress of 1,990 people with pre-diabetes, some of whom were taking medication to lower blood-sugar levels, some of whom were asked to make lifestyle change, and some of whom did neither.

Trial participants were randomly assigned to one of the three groups. One group was asked to make lifestyle changes, while the second group was given the drug metformin, which lowers blood sugar. A third, control group was given a placebo.

Overall, patients who reduced their blood sugar levels to normal, even for a brief period, were 56% less likely to develop type 2 diabetes, regardless of what methods they used.

According to study lead author Leigh Perreault, of the University of Colorado, the findings draw attention to the significant long-term reduction in diabetes risk when someone with pre-diabetes returns to normal glucose regulation.

Perreault said the study was supportive of a shift in the standard of care to early and aggressive glucose-lowering treatment in patients at highest risk.

Meanwhile, Natalia Yakubovich of Canada's McMaster University said that the findings clearly suggested that restoring normal blood sugar levels was clinically relevant.

According to Yakubovich, the identification of regression to normal glucose regulation could be an important way to stratify people into those at higher and lower risk of progression to diabetes.

She said such a stratification could help healthcare professionals identify which patients were most in need of additional treatment to prevent them developing diabetes in the first place, or to slow down the progression of the disease once it had appeared.

Perreault said that the biggest risk for people with pre-diabetes is that about 70% of them will develop type 2 diabetes over their lifetime, and that pre-diabetes is the driving force behind the diabetes epidemic.

About 11% of people currently identified in the US as having pre-diabetes go on to develop full diabetes annually.

Perreault and colleagues also presented their study findings at a meeting of the American Diabetes Association in Philadelphia.


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