What are the pharmacotherapy options for treating prediabetes?

Giuseppe Daniele, Muhammad Abdulghani, Ralph A. Defronzo

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Introduction: The incidence of type 2 diabetes mellitus (T2DM) has risen to epidemic proportions, and this is associated with enormous cost. T2DM is preceded by 'prediabetes', and the diagnosis of impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) provides an opportunity for targeted intervention. Prediabetic subjects manifest both core defects characteristic of T2DM, that is, insulin resistance and β-cell dysfunction. Interventions which improve insulin sensitivity and/or preserve β-cell function are logical strategies to delay the conversion of IGT/IFG to T2DM or revert glucose tolerance to normal.

Areas covered: The authors examine pharmacologic agents that have proven to decrease the conversion of IGT to T2DM and represent potential treatment options in prediabetes.

Expert opinion: Weight loss improves whole body insulin sensitivity, preserves β-cell function and decreases progression of prediabetes to T2DM. In real life long-term weight loss is the exception and, even if successful, 40-50% of IGT individuals still progress to T2DM. Pharmacotherapy provides an alternative strategy to improve insulin sensitivity and preserve β-cell function. Thiazolidinediones (TZDs) are highly effective in T2DM prevention. Long-acting glucagon-like peptide-1 (GLP-1) analogs, because they augment β-cell function and promote weight loss, are effective in preventing IGT progression to T2DM. Metformin is considerably less effective than TZDs or GLP-1 analogs.

Original languageEnglish
Pages (from-to)2003-2018
Number of pages16
JournalExpert Opinion on Pharmacotherapy
Volume15
Issue number14
DOIs
Publication statusPublished - 1 Oct 2014

Keywords

  • Glucagon-like peptide-1 analogs
  • Pharmacotherapy
  • Prediabetes
  • Weight loss

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