Should You Take Medications to Prevent Diabetes?   (October 29, 2013)

I recently saw the following question:

Should I take meds to prevent Diabetes Type 2? I am 30 years old and I have three fasting plasma glucose levels: 97 mg/dL (6 months ago), 98 mg/dL (4 months ago) and 98 mg/dL (15 days ago). My BMI is 23. My hemoglobin A1c (HbA1c) level is 5.5%. My mother is diabetic type 2 and I am afraid to be developing the same disease. Do you think it is better take medications like biguanides, sulfonylureas, or meglitinide derivatives to prevent it? Thanks.

My reply:

As you are very much aware, the risk factors for developing type 2 diabetes include heredity. They also include advancing age, race, obesity, and inactivity. There’s not much you can do about some of these, but lifestyle changes to prevent or treat obesity, and increasing activity levels should be on everyone’s list to help delay or prevent diabetes.

You ask whether adding prescription medications might help prevent diabetes.  Most of the studies evaluating using medications for prevention of diabetes used the drugs as “add-ons” in addition to lifestyle changes, and usually these studies were done in people with prediabetes.

There’s evidence that using metformin might help: the DPP study has shown that people at high risk for type 2 diabetes can sharply lower their chances of getting the disease with meal planning and exercise. The medication metformin also reduced diabetes risk, though less dramatically.

Other drugs have also been evaluated: Acarbose (Precose), either as an alternative or in addition to changes in lifestyle, delayed development of type 2 diabetes in patients with impaired glucose tolerance.

And low-dose insulin glargine (Lantus) reduced new-onset diabetes In patients with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes.

But nateglinide (Starlix, a meglitinide) did not reduce the incidence of diabetes (or  cardiovascular outcomes) in patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors.

Since your BMI, A1C, and BGLs are all normal, you don’t have prediabetes at this time, and very few physicians would advise that you start prescription medications (with their attendant risks and financial cost) -- unless you were participating in a clinical study.

But you should look at making lifestyle changes, and there are other issues you should review with your physician which won’t directly decrease your risk of diabetes, but should be considered in terms of your future health, especially heart disease and stroke:

1)     Daily low-dose aspirin, unless you have a contraindication.

2)     Aggressive treatment of hypertension.

3)     Aggressive treatment of elevated lipid levels.

4)     Stop smoking.

Hope this helps!