CardioExchange Archive

Prediabetics — people with impaired fasting glucose or impaired glucose tolerance — can reduce their high risk for progressing to diabetes if they achieve even a transient return to normal glucose regulation, according to results of the Diabetes Prevention Program Outcomes Study (DPPOS), presented at the American Diabetes Association meeting and published simultaneously online in the Lancet.

Leigh Perreault and colleagues in the Diabetes Prevention Program Research Group analyzed data from 1,990 participants who had been randomized in the original DPP study to intensive lifestyle intervention, metformin, or placebo. The risk for developing diabetes was 56% lower in the participants who at some point during the DPP study had normal glucose regulation than in the participants who continued to have prediabetes (hazard ratio, 0.44; 95% CI, 0.37–0.55; P<0.0001). Diabetes prevention strongly correlated with the number of times that participants were found to have normal glucose regulation.

Attaining normal glucose regulation at any point during the study was the essential protective variable in preventing diabetes, regardless of the participants’ assigned treatment group. Among participants who remained consistently prediabetic, the risk for developing diabetes was significantly higher in the intensive lifestyle intervention group than in the placebo group.

The investigators wrote that the results of their study suggest “that the strategy is unimportant as long as the intervention is early (when someone has prediabetes) and can restore normal glucose regulation, even if transiently. Further, maintenance of prediabetes despite the potent glucose-lowering effects of intensive lifestyle modification represents a high-risk state and might warrant additional preventive strategies.”

In an accompanying comment, Natalia Yakubovich and Hertzel Gerstein write that “identification of regression to normoglycemia could be an important way to stratify people into those at higher and lower risk of progression to diabetes. Such stratification could therefore identify individuals for whom additional treatment might be needed to prevent diabetes or to slow down disease progression.”