Drugs to Prevent Diabetes Questioned
Researchers Say Medication Less Effective Than Lifestyle Changes for Prevention
WebMD News Archive
April 26, 2007 -- Drugs used to treat diabetes are increasingly being
prescribed to prevent the disease, but the strategy is being questioned by
Writing in the latest issue of BMJ, three diabetes researchers argue
that the drug Avandia and other diabetes drugs should not be used for disease
prevention because the long-term benefits of such treatments are not known.
Avandia was found to lower type 2 diabetes risk by 62% among people at high
risk for developing the disease in a large, international trial reported last
The risk reduction was double that reported with any other drug used for
diabetes prevention and on par with reductions reported for lifestyle
But it is not yet clear if this benefit translates into a lower risk for
common diabetes-related complications -- like heart disease, kidney failure,
and blindness -- says Mayo Clinic endocrinologist Victor Montori, MD, ScD.
He tells WebMD that because there is a clear cost and potential risk for
harm, the threshold for using drugs to lower diabetes risk must remain very
"Prescribing pills to prevent [diabetes] has the effect of converting
people into patients," he says. "You transform essentially healthy
people concerned about their health into patients who require regular doctor
visits and laboratory tests to monitor the drugs they are on."
54 Million at Risk
About 20 million Americans have diabetes, and millions more are considered
to have a high risk of developing the disease. According to the American
Diabetes Association, as many as 54 million Americans are believed to have
prediabetes, meaning that blood sugar, or glucose, levels are elevated but not
high enough to be diabetes.
Avandia and a similar drug, Actos, lower blood sugar by helping the body use
its natural insulin better. Insulin is a hormone in the body that is necessary
to keep blood sugar in check.
But research suggests that this benefit lasts only as long as people remain
on the drugs, American Diabetes Association President Larry C. Deeb, MD, tells
Deeb says it is clear that drugs are less effective than lifestyle changes
for preventing diabetes and diabetes-related complications.
"Regular exercise and a healthy lifestyle benefit patients in many more
ways than preventing diabetes," he says. "The benefits in terms of
bones and cardiovascular health are much more than you could ever get from a
But he adds that drugs are often the only preventive strategy doctors have
to offer when patients don't make the lifestyle changes they need to make.
"Physicians are trained to help patients, not to stand by and do
nothing," he says.
'Impossible to Justify'
Montori and colleagues wrote that it is "at present, impossible to
justify" the use of Avandia and Actos -- the two approved drugs in the
class also commonly known as glitazones -- for use in at-risk patients.
"If clinicians offer patients glitazones to prevent diabetes, they are
offering certain inconvenience, cost, and risk for largely speculative
benefit," they write. "Lifestyle changes are clearly at least as
effective as glitazones and can be implemented considerably more
Calls from WebMD to Avandia manufacturer GlaxoSmithKline were not returned
in time for publication.