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© 2005 by the American Diabetes Association, Inc.
Reviews/Commentaries/ADA Statements |
A Systematic Review of Drug Therapy to Delay or Prevent Type 2 Diabetes
1 Department of Medicine, University of Alberta, Edmonton, Canada
2 Institute of Health Economics, Edmonton, Canada
3 Department of Public Health Sciences, University of Alberta, Edmonton, Canada
Address correspondence and reprint requests to Raj Padwal, Department of Medicine, 2E3.22 Walter C. Mackenzie HSC, University of Alberta Hospital, 8440-112th St., Edmonton, AB, Canada, T6G 2B7. E-mail: rpadwal{at}ualberta.ca
OBJECTIVE—To systematically review the evidence for the prevention of type 2 diabetes by pharmacological therapies.
RESEARCH DESIGN AND METHODS—Randomized controlled trials and cohort studies examining the effect of oral hypoglycemic agents, antiobesity agents, antihypertensive agents, statins, fibrates, and estrogen on the incidence of type 2 diabetes were identified from MEDLINE, EMBASE, the Cochrane Controlled Trials Registry, and searches of reference lists. Two reviewers independently assessed studies for inclusion and performed data extraction.
RESULTS—Ten studies of oral hypoglycemic agents and 15 studies of nonoral hypoglycemic agents were found. Oral hypoglycemic agents and orlistat are the only drugs that have been studied in randomized controlled trials with diabetes incidence as the primary end point. In the largest studies of 2.5–4.0 years’ duration, metformin (relative risk [RR] 0.69, 95% CI 0.57–0.83), acarbose (0.75, 0.63–0.90), troglitazone (0.45, 0.25–0.83), and orlistat (hazard ratio [HR] 0.63, 95% CI 0.46–0.86) have all been shown to decrease diabetes incidence compared with placebo; however, follow-up rates varied from 43 to 96%. Current evidence for statins, fibrates, antihypertensive agents, and estrogen is inconclusive. In addition, the critical question of whether drugs are preventing, or simply delaying, onset of diabetes remains unresolved.
CONCLUSIONS—Currently, no single agent can be definitively recommended for diabetes prevention. Future studies should be designed with diabetes incidence as the primary outcome and should be of sufficient duration to differentiate between genuine diabetes prevention as opposed to simple delay or masking of this condition.
Abbreviations: DPP, Diabetes Prevention Program • IGT, impaired glucose tolerance • RCT, randomized controlled trial • STOP-NIDDM, Study To Prevent Noninsulin-Dependent Diabetes Mellitus
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