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Should the Metabolic Syndrome Patient with Prediabetes Be Offered Pharmacotherapy?

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Abstract

Impaired fasting glucose and impaired glucose tolerance reflect perturbations in glucose metabolism and define a prediabetic state in which risk for type 2 diabetes mellitus (T2DM) is increased. There is overlap between prediabetes and the metabolic syndrome, which itself increases the risk for T2DM and cardiovascular disease. The utility of medical interventions to prevent progression to diabetes in prediabetic individuals, many of whom also manifest metabolic syndrome, has been examined in several large clinical trials. Intensive lifestyle intervention consistently results in drastic reductions in the incidence of T2DM and reversal of metabolic syndrome. Additionally, pharmacotherapies—including metformin, acarbose, thiazolidinediones, glucagon-like peptide 1 receptor agonists, and renin-angiotensin inhibitors—also reduce diabetes incidence with variable effects on metabolic syndrome components. Taken together, we recommend that prediabetic patients undergo intensive lifestyle intervention, with the addition of pharmacotherapy based on the presence of specific features of the metabolic syndrome, for diabetes prevention.

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Abbreviations

ACT NOW:

Actos Now for the Prevention of Diabetes

DECODE:

Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe

DPP:

Diabetes Prevention Program

DREAM:

Diabetes Reduction Assessment with Ramipril and Rosiglitazone

NAVIGATOR:

Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research

ONTARGET:

Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial

PIPOD:

Pioglitazone in Prevention of Diabetes

STOP-NIDDM:

Study to Prevent Non-Insulin-Dependent Diabetes Mellitus.

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Authors and Affiliations

  1. Department of Endocrinology, Washington Hospital Center, 110 Irving Street, NW, Suite 2A-72, Washington, DC, 20010, USA

    Shannon D. Sullivan

  2. Medstar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattesville, MD, 20872, USA

    Robert E. Ratner

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  1. Shannon D. Sullivan
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Correspondence to Robert E. Ratner.

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Sullivan, S.D., Ratner, R.E. Should the Metabolic Syndrome Patient with Prediabetes Be Offered Pharmacotherapy?. Curr Diab Rep 11, 91–98 (2011). https://doi.org/10.1007/s11892-010-0170-y

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