Over 20 million people in the United States have diabetes mellitus, and that estimate from the Centers for Disease Control and Prevention (http://www.cdc.gov/diabetes/pubs/estimates.htm) may even be a conservative one. Diabetes has many life threatening complications, including those that affect the heart, liver, kidneys, eyes and nervous system, just to name a few. What if there was a way to prevent diabetes from occurring? Is this a reality or merely a DREAM?
Early research by the Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM) group is showing that one of the above medications, rosiglitazone, is indeed effective as a diabetes prevention agent. When overt diabetes occurs, the risks of heart and kidney disease are markedly increased. Preventing or delaying the onset of diabetes, particularly among people who are at high risk, is an exciting development.
A multi-center trial involving 5,269 patients from 191 medical centers in 21 countries studied the effect of these two medications on people whose fasting blood sugars were high or who had impaired glucose tolerance. These were not overt diabetics on treatment or insulin, but rather those in whom progression to diabetes (sometimes called pre-diabetes) was high. These patients (some received the medications, others received a placebo) were followed for an average of three years. Researchers carefully monitored how many of each group actually developed full blown diabetes during that time period, as well as monitored the study participants for the incidence of stroke, heart attack, or other cardiac events.
Ramipril is a medication used to control blood pressure by blocking the production of substances in the body that constrict blood vessels. While successful in reducing the amount of cardiac events and complications and improving blood sugars a little, it was not considered significant in preventing the onset of diabetes. Those taking the medication for other reasons, such as high blood pressure or heart failure, may find an added benefit in a moderation of their blood sugar to some degree.
Rosiglitazone on the other hand showed striking findings. Rosiglitazone is a diabetes treatment medication used to increase the body’s sensitivity to insulin, as well as to stimulate cells that produce insulin. The American Diabetes Association summary of the DREAM trial showed that compared with those who took the placebo, people taking Rosiglitazone were 62% less likely to develop diabetes. They were also 70% more likely to return to normal blood sugar levels. There were few side effects or cardiac problems associated with the treatment, and in fact the number of cardiac events were decreased.
Is this going to change the way medicine is practiced? First, it is important to realize that those who are already under treatment for diabetes fall into a separate group- these individuals are already being treated aggressively with medication and lifestyle modifications and their standing won’t change. Second, medication should never be substituted for healthy living. Eating well, following a careful diet and maintaining normal weight, and exercising regularly to improve conditioning and facilitating already circulating insulin in the body to enter working cells and organ systems is essential. However, if people are at a higher risk of developing diabetes and they have made these lifestyle changes to both diet and exercise, medication can be considered to further delay the onset of the disease.
More research is needed to see how these results play out over the long term in preventing diabetes. So far however the DREAM has had an encouraging start.
The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.