When you’ve got diabetes, the management is clear – there are guidelines out there, foundations to refer to, medications to trial and so on. And if you haven’t – well, you haven’t. But what about those people in the grey zone?
Impaired glucose tolerance is a significant predictor for people likely to develop diabetes in the future, and is an independent marker of cardiovascular disease. Preventing diabetes would be a huge benefit, but so far pharmacological treatment hasn’t proven dramatically better than just encouraging lifestyle management.
This study from NEJM looks at using pioglitazone as a ‘preventative’ agents of sorts, and it does work – incidence of diabetes goes from 7.6% down to 2.1%. In fact, 48% converted to normal glucose tolerance (compared with 28% in the placebo group). The problem, as with all medical treatments, is side effects – primarily fluid retention and weight gain.
Early aggressive treatment of diabetes has been demonstrated to reverse some beta cell dysfunction, and this article (along with more to come, no doubt) may change our management of this early stage. Check out the article here.
By the way, check out the guidelines from Diabetes Australia here – the little book for GPs and the evidence based guidelines are both excellent. There’s also a risk calculator from the Australian Government here.