Friday, September 29, 2006

Diabetes Prevention

We are all very fearful of diabetes, especially T2DM, obviously because of the many profound complications of T2DM. There are many of us who feel that T2DM is a cardiovascular disease, because all the morbidity and mortalities from T2DM is a results of involvement of micro or macro-vessels.

The many diabetic societies have, rightly, produced criterias for a diagnosis of pre-diabetes, allowing us to pick up those who run a high risk of becoming diabetics before they actually become diabetic. This is helpful (as in the case of pre-hypertension), so that we can then treat these people aggressively either through life-style changes or medications, so they can avoid the scourge of diabetes.

This month, in Copenhagen, at the European Association for the Study of Diabetes 2006 meeting, researchers from Canada presented the findings of the "Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medications" or DREAM study. Basically, this was a study, to see if taking Ramipril or Rosiglitazone, reduces the risk or developing diabetes in patients at risk of diabetes, defined as patient with impaired fasting glucose or impaired glucose tolerance.

While there were many cardiac studies before this, eg HOPE, EUROPA and VALUE, which showed that patients with CAD, but who were not diabetics, when given ACE-I or ARBs for their cardiac condition had a lower incidence of T2DM. In fact there are many of my patients that showed such. Well, the DREAM investigators did not find that. From their study, they concluded that ramipril did not prevent the progression to T2DM whereas rosiglitazone did. One must remember that rosiglitazone is an insulin sensitiser, and in fact is a treatment for diabetes. More importantly, the study was funded by GSK, which adds a slightly bitter taste in the mouth. I think that for rosiglitazone, the bar has to be raised higher, meaning that we need to see if rosiglitazone treated patients in this study, after 5-10 years, had a lower incidence or no incidence of micro or macro-vascular disease. Now that will make early treatment of pre-diabetics worthwhile, and that is still left to be seen. Yes, it was a nice DREAM in summer, but I think the dream is too early and I certainly HOPE that it does not turn into a nightmare.

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