Early active control of blood sugar is the key to pre-diabetes treatment

The landmark analysis of the Diabetes Prevention Program (DPP) shows that early restoration of normal blood glucose levels in pre-diabetic patients is the key to preventing disease progression, whether through lifestyle interventions or medications .

Dr. Leigh Perreault, of the University of Colorado, and his colleagues reported that in fact, participants who participated in DPP were associated with a significant reduction in the risk of diabetes, even if blood glucose levels returned to normal for a brief period. DPP is a large-scale, multicenter, randomized trial that compares weight loss with adjusted diets and medications for the prevention of type 2 diabetes. The study was published online in the Lancet on June 9th (Lancet 2012 June 9 [doi:10.106/S0140-6736(12)60525-X]).

In DPP, all 3,234 subjects had a risk of developing diabetes at baseline. After randomization, these patients received lifestyle interventions, metformin, or placebo, respectively, and the median follow-up period during the intervention period was 3.2 years.

The ongoing post-intervention observational analysis of the Diabetic Prevention Plan Outcomes Study (DPPOS) has a median follow-up of 5.7 years. The results of the analysis showed that the risk of diabetes in the 894 participants whose glucose levels returned to normal during the intervention period was reduced by 56% compared to the 1,096 subjects who had been in prediabetes (hazard ratio [HR], 0.44). Moreover, the decrease in the risk of diabetes was significantly associated with the number of times that the patient's blood glucose levels were normal. Specifically, if only one blood glucose level adjustment is achieved, then the risk of diabetes is decreased by 47% (HR, 0.53); when it reaches two times, it is decreased by 61% (HR, 0.39); when it reaches three times, it is decreased by 67% (HR, 0.33).

According to the investigators, the reduction in the risk of diabetes in subjects whose blood glucose levels returned to normal during the intervention was not affected by the grouping. In DPPOS, factors associated with increased risk of diabetes included age less than 45 years (HR, 1.47) and African Americans (HR, 1.77).

The researchers also pointed out that what seems to be contradictory is that no matter what type of interventions were previously accepted, the risk of developing diabetes with significantly lower body weight during DPP is actually higher (HR, 1.26). The researchers believe that this is "probably because of the high proportion of patients with weight gain in DPPOS, which has a negative impact on the risk of diabetes."

The high body mass index at the beginning of DPPOS was also associated with the risk of diabetes during DPPOS follow-up (HR, 1.14). High beta cell function and insulin sensitivity are protective (HR = 0.80 and 0.83, respectively).

Subjects who had undergone lifestyle-enhanced interventions during DPP but were still pre-diabetic had a higher risk of developing diabetes in DPPOS than those who were not in the pre-diabetic and placebo groups (HR, 1.31). The researchers pointed out that this shows that pre-diabetic status after a rigorous lifestyle intervention suggests that the risk of diabetes is high and may require further intervention.

The researchers also pointed out: “Although everyone agrees that prevention of diabetes is of great significance, there is no consensus on specific interventions. The above analysis shows that as long as early intervention (starting from the discovery of pre-diabetes), no matter what This type of strategy will likely restore normal blood glucose regulation, even if it is only a brief recovery."

The study was funded by the National Institutes of Health. The authors declare no relevant economic conflicts of interest.