Long-term results of pharmacological correction of prediabetes

• Irina Yu. Demidova
• Valentina V. Boeva
• Alexander N. Zavyalov

Abstract

Low detectability of early disorders of carbohydrate metabolism (IGT/IFG) leads to late diagnosis of diabetes mellitus type 2 (T2DM), progression of its complications and the low effectiveness of oral therapy. Meanwhile, the start of pharmacological correction at the time of IGT/IFG onset allows delaying the development of T2DM for a long time and in some patients avoiding it at all.

The aim - to evaluate the long-term efficacy of pharmacological correction of newly detected IGT/ IFG to T2DM.

Material and methods. The observational non-randomized prospective study included patients with newly diagnosed IGT/IFG who were prescribed metformin and/or acarbose therapy for at least 3 years (maximum 13 years) and subsequently evaluated the frequency of conversion of IGT/IFG to T2DM after 10 years.

Results and discussion. In real clinical practice, 1136 people, whose normal state of carbohydrate metabolism was proved by prophylactic medical examination, were rescreened in compliance with all the rules for preanalytical preparation of blood samples. Carbohydrate metabolism disorders were detected: T2DM 5.0%, IGT 5.5%, IFG 8.0%, and normoglycemia was confirmed in 81.5%. A glucose tolerance test was performed in 494 (43.4%) people. Patients with IGT/IFG were prescribed metformin (77%), or metformin and acarbose (23%). Most patients independently discontinued therapy after the end of the period of active observation (3 years). 10 years after the end of active observation, the conversion rate of IGT/IFG to T2DM was 38.8% in the group without pharmacological prophylaxis and 0% in the metformin group (p<0.01). Among 30 patients who took metformin at a dose of 500 mg per day, normalization of carbohydrate metabolism was noted in 25 (83.3%) persons (р<0.05).

Conclusions. It was shown that the long-term use of metformin provided secondary prevention of the development of type 2 diabetes in the long term in 83.3% of patients.

Keywords:diabetes mellitus type 2, impaired fasting glucose, impaired glucose tolerance, screening, metformin, acarbose, prophylaxis, fasting venous plasma glucose, prediabetic state

References

1. International Diabetes Federation. Diabetes Atlas. 9^th ed; 2019.

2. The Federal register of patients with diabetes. Professional All-Russian Resource on Diabetes Nosology under the auspices of Endocrinology Research Center/http://diaregistry.ru/content/o-proekte.html#content Verified on May 28, 2018. (in Russian)

3. Algorithms of specialized medical care for diabetes mellitus patients. Edited by I.I. Dedov, M.V. Shestakova. 9^th ed. Moscow; 2019. (in Russian)

4. Dedov I.I., Shestakova M.V., Galstyan G.R. Prevalence of type 2 diabetes mellitus in adult Russian population (NATION study). Sakharni Diabet [Diabetes Mellitus]. 2016; 19 (2): 104-12. (in Russian)

5. Ametov A.S. Type 2 diabetes. Problems and solutions. Moscow: GEOTAR-Media, 2017; 6: 125-44. (in Russian)

6. Starodubova A.V., Chervyakova Yu.V., Kopelev A.A., Alieva A.M. Possibilities of medical correction of metabolic disorders and prevention of diabetes mellitus in disorders of carbohydrate metabolism. Lechebnoe delo [Medical Business]. 2015; (3): 59-65. (in Russian)

7. Barry E. Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions. BMJ. 2017; 356: i6538.

8. Diabetes Prevention Program Research Group. The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS. Diabetes Care. 2012; 35 (4): 723-30.

9. Аmetov А.S., Кrivosheyeva А.А. Prevention of type 2 diabetes mellitus. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2017; (4): 14-25. (in Russian)

10. Diabetes Prevention Program Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care. 2012; 35 (4): 731-7.

11. Chazova I.E., Mychka V.B., Belenkov Yu.N. The main results of the Russian program APRIL (the effectiveness of acarbose in patients with impaired glucose tolerance and hypertension). Consilium medicum. 2005; (2): 18-22. (in Russian)

12. Madsen K.S., Chi Y., Metzendorf M.I., Richter B., Hemmingsen B. Metformin for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus. Cochrane Dat Syst Rev. 2019: (12): CD 008558.

13. Demidova I.Yu., Boeva V.V. Early Diagnosis and treatment of initial stages of carbohydrate metabolism disorders. Vestnik Rossiyskogo gosudarstvennogo meditsinskogo universiteta [Bulletin of Russian State Medical University]. 2013; (1): 9-13. (in Russian)

14. 3. Prevention or delay of type 2 diabetes: Standards of medical care in diabetes-2019. Diabetes Care. 2019; 42 (Suppl. 1): S 29-33.

15. Аmetov А.S, Кrivosheyeva А.А. Prospects of early pharmacological intervention at the stage of prediabetes. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2018; 7 (3): 75-87.

16. Naidoo P., et al. Effect of sitagliptin and metformin on prediabetes progression to type 2 diabetes - A randomized, double-blind, doublearm, multicenter clinical trial: Protocol for the Sitagliptin and Metformin in PreDiabetes (SiMePreD) Study. JMIR Res Protoc. 2016; 5 (3): e145.

17. International Diabetes Federation. Clinical practice recommendations for managing type 2 diabetes in primary care. Brussels, 2017

18. The State Register of Medicines. Registration certificate. URL: http://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid = 7ff34cc5-7fbe-4cd4-9546-8dbdf1941b3c&t= (date of access: 12.08.2019) (in Russian)

19. The State Register of Medicines. Registration certificate. URL: http://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=a7f442c7-6246-412c-869f-db0dbb28623b&t= (date of access: 12.08.2019) (in Russian)

20. Decree of the Government of the Russian Federation of May 10, 2007. "On the federal target program "Prevention and control of socially significant diseases (2007-2012)" No. 280.

21. The results of the implementation of the "Diabetes mellitus" subprogram of the Federal target program "Prevention and Control of Socially Significant Diseases 2007-2012". Edited by Dedov I.I., Shestakova M.V. Sakharni Diabet [Diabetes Mellitus]. 2013; Special Edition 2S: 2-18.

22. Order of the Ministry of Health of Russian Federation оf December 3 2012 No. 1006н.

23. Chiasson J.-L., Josse R.G., Gomis R., Hanefeld M., Karasik A., Laakso M., et al. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002; 359 (9323): 2072-7.

24. Holman R., North B., Tunbridge F. Possible prevention of type 2 diabetes with acarbose or metformin. Diabetes. 2000; 49 (Suppl 1): A111.

25. Wenying Y., Lixiang L., Jinwu Q. The preventive effect of acarbose and metformin on the progression to diabetes mellitus in the IGT population: 3-year multicenter prospective study. Chin J Endocrin Metab. 2001; 17.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)