A Drug To Treat Diabetes Before It Begins

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A new study shows that people who are high risk of developing Type 2 diabetes may be able to prevent the disease by taking pioglitazone (sold as Actos), a common drug for diabetes treatment. But experts say that doesn’t mean everyone with high blood sugar levels should be taking the medication.

Diabetes often progresses from a condition of impaired insulin sensitivity to the full-blown disease. Doctors have long been eager to find medications or lifestyle changes that can slow this progression or stop it altogether. While 21 million Americans suffer from Type 2 diabetes, nearly four times as many have high blood sugar levels that put them at risk of developing the disease.

Now researchers led by Dr. Ralph DeFronzo at the Texas Diabetes Institute and University of Texas Health Science Center report in the New England Journal of Medicine that pioglitazone can be an effective tool in helping high-risk patients control their blood sugar and stop the onset of diabetes.

The drug helps diabetes patients become more sensitive to their body’s insulin; in Type 2 diabetes, the amount of insulin patients make isn’t sufficient to break down the sugar they consume in their diet.

Among more than 600 people with elevated blood sugar levels and at least one additional risk factor for diabetes — including a family history of diabetes, being overweight, high cholesterol levels or hypertension — 2% of those taking pioglitazone developed diabetes, compared with 7.6% of those in the placebo group, during the study’s more than two year follow-up, amounting to a 72% reduction in risk for those taking pioglitazone. In addition, more of the volunteers who took pioglitazone were able to restore their glucose tolerance to normal levels than those who were on placebo.

The reduction in diabetes risk seen in the new study was greater than that of other interventions that doctors currently use to help people with pre-diabetes avoid the disease. Another drug used to treat diabetes and control blood sugar, metformin, can lower risk by 31%; other medications in pioglitazone’s class have lowered risk by up to 62%; and lifestyle modifications such as diet and exercise have also reduced risk by 58%.

Still, as encouraging as the results are, the study’s authors caution that the data shouldn’t be a license to prescribe pioglitazone to everyone at high risk of developing diabetes. The drug belongs to the same class of anti-diabetes medications as rosiglitazone, or Avandia, which the Food and Drug Administration put on restricted use last fall after evidence that it increased patients’ risk of heart attack and stroke.

Pioglitazone has not been associated with such risks, but participants in the study who took the medication gained more weight than those taking placebo. While the gain was small, becoming overweight remains a strong risk factor for developing diabetes.

That’s why diabetes doctors continue to reserve drug-based treatments of pre-diabetes only for only those patients who have tried and failed to control their escalating blood sugar with non-pharmaceutical methods, such as diet and exercise. It may take longer and may not result in as dramatic a benefit as medications, but lifestyle options, experts say, are safer and potentially longer lasting.

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