Once-daily treatment with the diabetes drug pioglitazone (brand name Actos) was able to halt progression of prediabetes to Type 2 diabetes in a majority of people, report researchers from the University of Texas Health Science Center and seven collaborating institutions. Prediabetes currently affects an estimated 57 million people in the United States.
Pioglitazone is an oral medicine typically taken once a day, with or between meals, by people with Type 2 diabetes. The drug works by improving insulin sensitivity and decreasing the production of glucose in the liver. To see if pioglitazone could affect the progression from prediabetes (a condition in which blood glucose levels are elevated, but not yet within the diabetic range) to Type 2 diabetes, researchers recruited 602 people who were at high risk for diabetes based on their family history, obesity, and fasting plasma glucose levels between 95 mg/dl and 125 mg/dl. (Partial funding for the research was provided by pioglitazone’s manufacturer, Takeda Pharmaceuticals.) The participants were randomly assigned to take either pioglitazone or a placebo (inactive pill) once a day in the morning and were followed for an average of 2.4 years.
At the end of the follow-up period, the researchers found that, compared to placebo, pioglitazone reduced the progression from prediabetes to Type 2 diabetes by 72%. Additionally, use of pioglitazone was associated with a reduction in the rate of thickening of the carotid artery, which brings blood to the brain, as well as a lowering of blood pressure and an increase in the amount of HDL (“good”) cholesterol compared to placebo.
According to senior author Ralph DeFronzo, MD, “It’s a blockbuster study. The 72 percent reduction is the largest decrease in the conversion rate of prediabetes to diabetes that has ever been demonstrated by any intervention, be it diet, exercise, or medication.” Robert R. Henry, MD, President, Medicine & Science, of the American Diabetes Association, noted that “It is the most efficacious method we have studied to date to delay or prevent the onset of Type 2 diabetes.”
The medicine did have a number of side effects at the dose used in the study, including significant weight gain and fluid retention. (Another drug in this class, rosiglitazone [Avandia], was recently restricted by the US Food and Drug Administration due to safety concerns.) Additionally, it is unclear both what happens when a person stops taking the medicine and whether treating people with prediabetes is more effective than treating people after they have developed diabetes in terms of preventing complications. In an interview with Fox News, Jill Crandall, MD, a diabetes researcher at the Albert Einstein College of Medicine, said, “Lifestyle change, such as weight loss and exercise, remains the best option for those who can do it.”
To learn more about the study, read the article “Drug Prevents Type 2 Diabetes in Majority of High-Risk Individuals” or see the study’s abstract in The New England Journal of Medicine. And to learn more about pioglitazone, click here.