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Aggressive treatment of glucose levels in pre-diabetes ‘cuts diabetes risk by 70%’

Department of Health plans to radically expand GPs' treatment of patients at risk of diabetes have received a boost from a major study that showed reducing blood glucose levels to normal reduced their chances of developing the disease by up to 70%.

The US researchers said their results showed that ‘early and aggressive' treatment of pre-diabetes is warranted to radically reduce patients' risk of developing diabetes over six years.

The follow-up to the largest diabetes prevention study yet undertaken – published in the Lancet last week -  found the risk reduction for diabetes over nearly six years was ‘strongly associated' with the number of times normal glucose regulation had been achieved during the study.

Pulse revealed in March that the Department of Health was planning to expand the treatment of patients at risk of developing diabetes, by asking GPs to provide annual blood tests and lifestyle interventions in all at-risk patients.

These plans – currently being considered by NICE for their guideline on preventing diabetes – would mean practices would have to go through practice records and intervene in all patients at high risk, regardless of their HbA1c levels.

The study followed 1,990 patients with impaired glucose tolerance plus a fasting plasma glucose of 5.3-6.9mmol/l, who had been randomly assigned to lifestyle intervention, metformin, or placebo during the Diabetes Prevention Program in 1999-2001.

They looked at whether these patients developed diabetes over the six years after the trial ended, and correlated this with any measurements of normal blood glucose – defined as fasting glucose of less than 5.6 mmol/l - in the previous trial.

They found patients who had achieved a period of normal glucose levels were 56% less likely to develop diabetes than those who had no periods of normal glucose recorded, regardless of which arm they had been in the previous trial.

This increased to a reduction in risk of 61% if it was achieved twice, and 67% if it was reached three times in the previous trial.

The study authors concluded their findings supported a shift towards ‘early and aggressive measures' to prevent diabetes in people at high risk.

Study leader Dr Leigh Perreault, associate professor of medicine at the University of Colorado, USA, said: ‘The strategy is unimportant as long as the intervention is early and can restore normal glucose regulation, even if transiently.'

Dr Roger Gadsby, GP in Nuneaton and associate clinical professor at Warwick Medical School, told Pulse that the study provided a strong rationale to encourage GPs to intervene earlier.

He said: ‘We should encourage everyone at risk of developing diabetes to do their very best at lifestyle change because if they can get their blood glucose levels to normal they will reduce their risk of getting type 2 diabetes.'

However Dr Colin Kenny, GP in Dromore, Northern Ireland, and committee member of the Primary Care Diabetes Society, said aggressive treatment was not suitable for all patients: `A minority of approximately 40% don't go on to develop diabetes so you have a pyramid with diabetes on the top and a much bigger cohort of impaired glucose tolerance underneath.'

Dr Harry Yoxall, medical secretary of Somerset LMC, said the resources were not there for a full-scale diabetes prevention programme: ‘We would have to look at a completely new way of doing it because we don't have the resources.'

 

Reduction in diabetes risk

Reduced risk of progression to according to periods of normal glucose levels:

47% - once

61% - twice

67% - three times

Source: Lancet 2012, online 9 Jun

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