May 3, 2004 -- Improving blood sugar levels through exercise, weight loss, and medication can help prevent type 2 diabetes in people at risk. Now, new research suggests that lowering the levels of fat in the blood may also work
In a study from Israel's Tel Aviv University, the cholesterol-lowering drug bezafibrate was found to reduce the development of type 2 diabetes by almost a third and delay disease onset by roughly a year in a group of men with prediabetes.
Bezafibrate is not sold in the U.S., but two other drugs in the same class -- Lopid and Tricor -- are. These drugs lower levels of triglycerides, a form of blood fat linked to heart disease and poor blood sugar control. These drugs can also increase the level of HDL, or good, cholesterol in the blood.
"This is the first study to demonstrate that improving lipid metabolism can reduce the risk of type 2 diabetes in patients with coronary artery disease," lead researcher Alexander Tenenbaum, MD, PhD, says.
30% Reduction in Risk
At least 10 million Americans are at high risk for developing type 2 diabetes. Lifestyle interventions, like losing weight and exercising regularly, have proven to be the best ways to lower risk. In a major government-funded prevention trial reported in 2001, such interventions were found to lower diabetes risk by 58%, while taking the drug Glucophage was associated with a 31% reduction in risk. Glucophage helps sensitize the body to insulin.
In the study from Israel, published in an online edition of the journal Circulation, researchers reported a similar reduction in the risk of developing type 2 diabetes among prediabetic men taking bezafibrate.
The study involved 303 men with coronary artery disease, most of whom had had a previous heart attack. All the men in the study were said to have prediabetes based on an abnormally high fasting blood sugar. The level was not high enough to be diagnosed with type 2 diabetes. Roughly half of the men took bezafibrate daily, and the other half got placebos. All were followed for an average of six years.
During the follow-up period 42% of the men in the bezafibrate group and 54% of the men in the placebo group developed diabetes. When the researchers looked at all the factors that might increase an individual's risk of developing type 2 diabetes, they found that treatment with bezafibrate decreased the risk by 30%.
For those that developed type 2 diabetes, the average time it took for the onset of diabetes varied. Disease onset was 3.8 years in the placebo group and 4.6 years in the bezafibrate group.
More Study Needed
Fibrates, the class of drugs including bezafibrate, Lopid, and Tricor, are prescribed much less frequently in the U.S. for lowering cholesterol than statins, drugs that are much more effective in reducing LDL, or bad, cholesterol. While isolated studies suggested that statins also lower diabetes risk, vascular disease expert Jorge Plutzky, MD, tells WebMD that more recent trials found no protective effect for this class of drugs.
Bezafibrate is believed to lower diabetes risk in a similar way to a class of diabetes drugs known as the glitazones.
"With regard to diabetes risk, these drugs are similar in terms of their broad mechanism of action," says Plutzky, who is director of the vascular disease prevention program at Boston's Brigham and Women's Hospital and a faculty member at Harvard Medical School.
Plutzky says the Israeli findings, while intriguing, must be confirmed in trials specifically designed to examine the role of the fibrates in the prevention of type 2 diabetes.