Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Pharmacologic treatment options for prediabetes

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 380–381 (2008)Cite this article

Prevention of the global epidemic of type 2 diabetes mellitus (T2DM) is paramount. T2DM is one of the most common causes of adult blindness, end-stage kidney disease, nontraumatic amputation, and cardiovascular disease (CVD). In addition, patients with T2DM have a reduced lifespan and US health-care costs associated with T2DM are reported to exceed $100 billion annually. Clinical trials have provided compelling evidence that identification and treatment of individuals with prediabetes can prevent new-onset T2DM. Lifestyle changes such as exercise and weight loss are critical.1 Nonetheless, whether pharmacologic intervention should also be used remains a key question. Factors to consider include risk of T2DM (and its associated comorbidities), pathophysiologic mechanisms, adverse effects, and cost.

How can we recognize the high-risk patient? Impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) are both prediabetic conditions. IFG is characterized by fasting blood glucose levels of 5.5–6.9 mmol/l (100–125 mg/dl), whereas IGT is diagnosed in the presence of postprandial blood glucose levels of 7.8–11.0 mmol/l (140–199 mg/dl). IFG progresses to T2DM at an annual rate of 8–10%. By contrast, IGT converts at a rate of 10–12% annually. Individuals with combined IGT and IFG, morbid obesity, history of gestational diabetes mellitus, family history of T2DM, and multiple CVD risk factors have the greatest risk of developing T2DM.2 In addition, polycystic ovary syndrome and nonalcoholic steatohepatitis increase the risk of T2DM. Complications such as albuminuria, neuropathy and retinopathy can develop in the prediabetic state, which suggests a reduced glucose threshold for tissue injury. CVD rates are also increased in individuals with IGT or IFG compared with those with normoglycemia.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Tuomilehto J et al. (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344: 1343–1350

    Article  CAS  Google Scholar 

  2. Nathan DM et al. (2007) Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 30: 753–759

    Article  CAS  Google Scholar 

  3. Sladek R et al. (2007) A genome-wide association study identifies novel risk loci for type 2 diabetes. Nature 445: 881–885

    Article  CAS  Google Scholar 

  4. Chiasson JL et al. (2002) Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 359: 2072–2077

    Article  CAS  Google Scholar 

  5. DECODE Study Group (1998) Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data. DECODE Study Group on behalf of the European Diabetes Epidemiology Study Group. BMJ 317: 371–375

  6. Torgerson JS et al. (2004) Xenical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27: 155–161

    Article  CAS  Google Scholar 

  7. DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators (2006) Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet 368: 1096–1105

  8. Kahn SE et al. (2006) Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med 355: 2427–2443

    Article  CAS  Google Scholar 

  9. Nissen SE and Wolski K (2007) Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 356: 2457–2471

    Article  CAS  Google Scholar 

  10. ORIGIN Trial Investigators (2008) Rationale, design, and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: the ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention). Am Heart J 155: 26–32

Download references

Author information

Authors and Affiliations

  1. WA Hsueh is the Director of the Diabetes Research Center and Chief of the Division of Diabetes, Obesity and Lipids, Methodist Hospital Research Institute, Houston, TX, USA,

    Willa A Hsueh

  2. Y Handelsman is the Medical Director of the Metabolic Institute of America, Tarzana, CA, USA.,

    Yehuda Handelsman

Authors
  1. Willa A Hsueh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yehuda Handelsman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Willa A Hsueh.

Ethics declarations

Competing interests

WA Hsueh has declared associations with the following companies: GlaxoSmithKline (consultant and grant/research support), Merck (speakers bureau) and Novartis (consultant and grant/research support).

Y Handelsman has declared associations with the following companies: Amylin (speakers bureau), AstraZeneca (speakers bureau), Bristol-Myers Squibb (speakers bureau), GlaxoSmithKline (consultant and speakers bureau), Merck (speakers bureau), Novartis (speakers bureau), and Sankyo (consultant and grant/research support).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hsueh, W., Handelsman, Y. Pharmacologic treatment options for prediabetes. Nat Rev Endocrinol 4, 380–381 (2008). https://doi.org/10.1038/ncpendmet0842

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpendmet0842

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing