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Taking pills to prevent diabetes cannot be justified, a study has found.
Theinvestigators, led by Professor Victor Montori of Mayo Clinic Collegeof Medicine in the USA, argue that lifestyle changes such as modestweight loss and physical activity are equally effective, much safer,and cheaper.
Diabetes affects some 4% of the worldpopulation and is associated with high financial and human costs. Thismakes preventing diabetes a public health priority.
Arecent trial showed that the drug rosiglitazone reduced the risk ofdiabetes in people at risk. The results have prompted aggressivepromotion of rosiglitazone as a preventive therapy. But ProfessorMontori and colleagues warn that this strategy will bring harm andadditional costs, while benefits for patients remain questionable.
Severaltrials have assessed drugs’ ability to prevent diabetes, but none hasshown that attempted prevention with drugs improves outcomes importantto patients. Evidence is also emerging of serious side-effects ofglitazones.
If clinicians offer patients glitazones toprevent diabetes, they are offering certain inconvenience, cost, andrisk for largely speculative benefit, the authors say. Lifestylechanges are at least as effective as glitazones and can be implementedconsiderably more cheaply.
The investigators conclude:”Clinical use of glitazones to prevent diabetes is, at present,impossible to justify because of unproved benefit on patient importantoutcomes or lasting effect on blood glucose levels, increased burden ofdisease labelling, serious adverse effects, increased economic burden,and availability of effective, less costly lifestyle measures.”
BMJ 2007;334:822-4
