Drug treatment in pre-diabetes
DOI:
https://doi.org/10.32385/rpmgf.v25i6.10690Keywords:
Type 2 Diabetes Melitus, Prediabetic State, TherapeuticsAbstract
Objectives: Type 2 Diabetes Mellitus (DM2) is a serious health problem associated with an increased morbidity, mortality and healthcare costs. It is often preceded by altered metabolic states as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). Lifestyle modification in patients with IGT showed a reduced incidence of DM2. Pharmacological therapy seems to prevent or at least delay the progression of DM2 in high risk patients, but doubts exist about their real benefit. The aim of this paper is to determine the real benefits in the use of pharmacological therapy in prediabetic states. Data sources: A systematic review of articles in Portuguese, English or Spanish language, published between January 2008 and September 2008, was conducted in the medical databases National Guideline Clearinghouse, Bandolier, DARE, NHS and Medline using the keywords prediabetic state, prediabetes and therapeutics. Methods of review: 103 articles were obtained.Those that compared the use of drugs in prediabetic states versus placebo or lifestyle change were included. SORT classification was used to attribute the level of evidence and strength of recommendation. Results: Nine articles were included in the review (4 guidelines, 1 meta-analysis, 3 systematic reviews and 1 randomized clinical trial). Some antidiabetic agents (metformin, acarbose and glitazones) and orlistat demonstrated a reduction in the risk of development of DM2 in pre-diabetic patients, remaining unclear if this benefit subsists after their withdrawal.Acarbose as also shown to reduce the progression of thickening of the intima layer in the carotid artery. Conclusion: Although certain antidiabetic agents and orlistat have showed to reduce the risk of development of diabetes in pre-diabetic patients, the available evidence does not demonstrate patient oriented benefits with its use, since none of the studies evaluated morbidity, mortality or cost-effectiveness associated with the pharmacological therapy. Some studies that aim to clarify these issues are being conducted.Downloads
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