Prediabetes Treatment

Submitted by Thiruvelan on Sat, 12/22/2018
Prediabetes Treatment

Beta-cell dysfunction and insulin resistance contribute to the development of prediabetes. Thus, improving insulin sensitivity and beta-cell function can be the best prediabetes treatment.

Lifestyle intervention as Prediabetes Treatment

Insulin resistance of the liver, muscle, and adipose tissue and impairment of beta cell function are the common defect that causes prediabetes.

Thus, efforts to preserve or increase beta cell functions and decrease insulin resistance could be a potent way to treat prediabetes and stop progression to type 2 diabetes.

Insulin resistance is the body cells (liver, muscle, and adipose tissue) do not respond well to the insulin, so not able to properly take up glucose from the blood. As a result, the pancreas makes more insulin to help glucose enter the cells. It puts extra strain on the pancreas that leads to impairment of pancreatic beta-cell function.

Impairment of beta-cell function - The first-phase insulin secretion deteriorates gradually when the fasting plasma glucose exceeds 90 mg/dL. And is almost completely lost when it reaches over 110 mg/dL. Ref: Diabetes. 1988 Jun; 37(6):667-87., Diabetes. 2009 Apr; 58(4):773-95., Am J Physiol Endocrinol Metab. 2008 Aug; 295(2): E401-6., and Diabetologia. 2004 Jul; 47(7):1157-1166.

Individuals in the high level of impaired glucose tolerance are maximally insulin resistant, and decline in beta-cell function is about 70% to 80%. 

Prediabetes Treatment – a Lifestyle change

Losing weight improves insulin sensitivity and preserves beta-cell function and inhibits progression to type 2 diabetes.

Clinical studies have shown that losing weight using diet and exercise improves insulin sensitivity and betterment of beta-cell function. Thus this is an excellent way to stop or slow down the progression of prediabetes to type 2 diabetes.

References:

  1. The New England Journal of Medicine 2001; 344:1343–1350.
  2. Diabetes. 2005; 54:2404–2414.
  3. Lancet. 2008; 371:1783–1789.

A weight loss of 5 to 7 % and 150 minutes of moderate exercise per week can reduce the progression of prediabetes to type 2 diabetes by 58 %.

Losing weight through lifestyle interventions, pharmacologic therapies or bariatric surgery augments insulin sensitivity, decreases beta-cell work overload, and betterment of glucose tolerance. Reference: Diabetologia. 2011 Oct; 54(10):2506-14 and the American Journal of Clinical Nutrition 2004 Jan; 79(1):22-30.

When individuals lose 5% of their body weight, total body insulin sensitivity improves by 30%. Reference: Diabetes. 2005 Aug; 54(8):2404-14. And a decrease in their progression from prediabetes to type 2 diabetes nearly by 58%. Reference: The New England Journal of Medicine 2002 Feb 7; 346(6):393-403.

Prediabetes Treatment – Pharmacotherapy

Pharmacotherapy is the next option to improve insulin sensitivity and beta-cell function if the lifestyle intervention failed to produce a result.

Clinical studies show Pharmacotherapy improve insulin sensitivity. Also, It found to diminish the progression of prediabetes to type 2 diabetes.

Metformin may be useful in the treatment of prediabetes.

Fasting plasma glucose concentration and hemoglobin A1C can be decreased by metformin in type 2 diabetes through inhibition of liver glucose production or through preserving beta-cell function. 

References: 

  1. The New England Journal of Medicine 1995 Aug 31; 333(9):541-9.
  2. The Journal of Clinical Endocrinology and Metabolism 1991; 73:1294–1301.
  3. The Journal of Clinical Endocrinology and Metabolism 1996; 81:4059–4067.
  4. The Journal of the American Medical Association. 1999; 281:2005–2012.

Thus, it is not unusual to claim that metformin would significantly lower the conversion rate from prediabetes to type 2 diabetes.

American Diabetes Association advice metformin usage in high-risk individuals (younger than 60-year, BMI over 30 kg/m2 and HbA1c over 6.0%) with prediabetes (either IGT or IFG).

Metformin is a drug that safely improves the body’s insulin sensitivity. It enables people to lose weight, help improve the underlying metabolic problem, and progression to diabetes type 2.

Pioglitazone is also useful for the treatment of prediabetes with some additional benefits. Pioglitazone decreases triglyceride concentrations and increases HDL levels while losing weight lowers blood pressure and heals lipid profile. The New England Journal of Medicine 2002 Feb 7; 346(6):393-403. However, Pioglitazone has few side effects that need to take into account before using it. 

Another option is to initiate metformin plus low-dose pioglitazone. In high-risk IGT, individuals’ long-acting GLP-1 analog use along with diet and exercise, maybe the best option.

Lifestyle intervention or Metformin, which one is best?

The lifestyle intervention was more effective than metformin.

Lifestyle changes and metformin treatment both reduced the incidence of diabetes in persons at high risk. A study confirms lifestyle intervention is the better option compared to metformin. The New England Journal of Medicine 2002; 346:393-403.  

It is recommended to follow a strict lifestyle modification for patients with prediabetes (IGT ± IFG). 

Blood sugar normalized – what to do?

Even if the blood sugar returned to normal, you still need to follow a healthy lifestyle to stay on track. Also, you should maintain a healthy weight and have your blood glucose checked at least every three years. If you discontinue a healthy lifestyle and gaining weight, then your prediabetes or diabetes will likely to return.