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Medications That Can Reduce The Conversion To Type 2 Diabetes

Oct 12, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Nadeen Ayad, BCPS, PharmD Candidate, Skaggs School of Pharmacy, University of Colorado

Pharmacological interventions may have a role to play in preventing conversion to type 2 diabetes, but are they more important than lifestyle factors?

Interventions to prevent type 2 diabetes have become a high priority for clinicians and policymakers. While promoting healthier physical activity and lifestyle changes is widely recommended, this may be not as effective solely. Some medications may potentially be able to delay the biochemical conversion to type 2 diabetes; however, the extent to which they can avert undesirable consequences of type 2 diabetes such as microvascular complications is unclear. This systematic review was conducted to evaluate the effect of pharmacological interventions on the biochemical conversion to type 2 diabetes.

Forty-three randomized controlled trials were included in this systematic review, of which 37 trials provided quantitative data for meta-analysis. The trials included a total of 192,156 participants, mean age 60 years, mostly whites but included smaller proportions of Asians, Native Americans, and Hispanic enrollees. The trials had an almost equal number of males and females and had a mean BMI of 30.4 kg/m2. The primary outcome evaluated was the incidence of type 2 diabetes.

The following pharmacological interventions were included in the review: α-glucosidase inhibitors (AGIs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), meglitinides, metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonist (GLP-1 agonists), sulfonylureas, orlistat, phentermine/topiramate, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and statins.

AGIs reduced the risk of biochemical conversion to type 2 diabetes by an RR of 0.68 (95% CI 0.52-0.88), ACEIs reduced the risk by an RR of 0.81 (95% CI 0.68-0.96); ARBs, metformin, orlistat, phentermine/topiramate, and pioglitazone all significantly reduced the risk of biochemical conversion to type 2 diabetes. However, nateglinide increased the risk by an RR of 1.06 (95% CI 1.01-1.12) and statins increased the risk by an RR of 1.1 (95% CI 1.03-1.18). DPP-4 inhibitors, GLP-1 agonist, sulfonylureas and SGLT-2 inhibitors were not associated with any significant changes in the biochemical conversion to type 2 diabetes.

Most trials included in this review were funded by industry which may have created a bias for the sponsored products more often than in independent trials. In addition to that, most trials did not include a washout period which could increase the risk of biased results favoring a beneficial effect.

The researchers suggest that taking diabetes medications to prevent the biochemical conversion to type 2 diabetes could be beneficial only if their use could potentially alter the clinical course by averting severe forms of type 2 diabetes. The available evidence demonstrates the extent to which medications lower glycemia in a way that could mask or delay the biochemical conversion; hence, no recommendation could be made in relation to the goal of preventing type 2 diabetes through pharmacological interventions. Therefore, to date, lifestyle interventions are still the most reasonable initial approach to prevent progression to diabetes in patients with prediabetes.

Practice Pearls:

  • This systematic review was conducted to evaluate the effect of pharmacological interventions on the biochemical conversion to type 2 diabetes.
  • AGIs reduced the risk of biochemical conversion to type 2 diabetes as well as ACEIs and ARBs, metformin, orlistat, phentermine/topiramate, and pioglitazone which all significantly reduced the risk of type 2 diabetes.
  • Lifestyle interventions are still the most reasonable initial approach to prevent progression to diabetes in patients with prediabetes.

Domecq JP, et al. Medications affecting the biochemical conversion to type 2 diabetes: A systematic review and meta-analysis. 2019 Sept; 104 (9).

Nadeen Ayad, BCPS, PharmD candidate, Skaggs School of Pharmacy, University of Colorado.