Diabetes Care
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Diabetes Care 30:e45 2007
DOI: 10.2337/dc07-0263
© 2007 by the American Diabetes Association
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Online Letters: Comments and Responses

Clinical Implications of the DREAM Study

Response to Kanat

Mayer B. Davidson, MD

From the Clinical Center for Research Excellence, Charles R. Drew University, Los Angeles, California

Address correspondence to Dr. Mayer B. Davidson, Charles R. Drew University, Clinical Center for Rearch Excellence, 1731 E. 120th St., Los Angeles, CA 90059. E-mail: mayerdavidson{at}cdrewu.edu

Because impaired fasting glucose (IFG) in the DREAM study (1) was defined at the time of recruitment as a fasting plasma glucose (FPG) concentration of ≥6.1 to <7.0 mmol/l (110–125 mg/dl), Dr. Kanat (2) raises the possibility that patients with FPG levels of 5.6–6.0 mmol/l (100–109 mg/dl), which fall within the more recent American Diabetes Association definition of IFG (3), might not respond similarly to rosiglitazone. This seems unlikely, since these subjects have less of an abnormality of glucose homeostasis than those who fulfill the older criterion. Furthermore, there are two bits of evidence against his contention. In the Diabetes Prevention Program (DPP) (4), subjects were selected with FPG concentrations as low as 5.3 mmol/l (95 mg/dl) and responded to the drug and lifestyle interventions. Second, in the same study (5), before the troglitazone (Rezulin) arm was discontinued, the response in subjects receiving this drug for up to 1.5 years (mean 0.9) was even better than in those undergoing the intensive lifestyle intervention and was similar to the response seen with rosiglitazone in the DREAM study (1). Whether thiazolidinediones actually delay the development of type 2 diabetes, as troglitazone seemed to do in women with gestational diabetes (6), or simply treat rising glycemia, as seemed to be the case in the troglitazone arm of the DPP (5), is not clear. Perhaps the follow-up evaluation of the subjects in the DREAM study will shed light on this important question.

References

  1. The DREAM (Diabetes Reduction Assessment with Rampiril and Rosiglitazone Medication) Trial Investigators: Effect of rosiglitazoe on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomized controlled trial. Lancet 368:1096–1105, 2006[Medline]
  2. Kanat M: Clinical implications of the DREAM study: response to Davidson (Letter). Diabetes Care 30:e44, 2007. DOI: 10.2337/dc07-0245[Free Full Text]
  3. Genuth S, Alberti KG, Bennett P, Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, Kitzmiller J, Knowler WC, Lebovitz H, Lernmark A, Nathan D, Palmer J, Rizza R, Saudek C, Shaw J, Steffes M, Stern M, Tuomilehto J, Zimmet P, Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 26:3160–3167, 2003[Free Full Text]
  4. The Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403, 2002[Abstract/Free Full Text]
  5. Knowler WC, Hamman RF, Edelstein SL, Barrett-Connor E, Ehrmann DA, Walker EA, Fowler SE, Nathan DM, Kahn SE, Diabetes Prevention Program Research Group: Prevention of type 2 diabetes with troglitazone in the Diabetes Prevention Program. Diabetes 54:1150–1156, 2005[Abstract/Free Full Text]
  6. Buchanan TA, Xiang AH, Peters RK, Kjos LK, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP: Preservation of pancreatic ß-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk Hispanic women. Diabetes 51:2796–2803, 2002[Abstract/Free Full Text]

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This Article
Right arrow Extract Freely available
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