By Lilian Anekwe
Adding a prandial glucose regulator to a lifestyle advice in patients with impaired glucose does not reduce their chances of developing diabetes – even if they have cardiovascular disease or cardiovascular risk factors.
The NAVIGATOR trial randomly assigned 9,300 patients with impaired glucose tolerance to either nateglinide up to 60mg three times daily, or a placebo, in addition to participation in a lifestyle modification programme.
After a median of five years of follow-up, 36% of the nateglinide group had been diagnosed with type 2 diabetes, compared to 34% of the placebo group, a 7% relative increase.
There was also no significant difference in a composite cardiovascular outcome of death from cardiovascular causes, hospitalisations from heart failure and non-fatal heart attacks or strokes.
Professor Rury Holman, director of the Diabetes Trials at the University of Oxford, concluded: ‘nateglinide offers no protection from the progression of impaired glucose tolerance to diabetes or from the progression of cardiovascular disease, and possibly raises glucose levels after a glucose challenge.'
N Engl J Med published online March 14 2010