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Prevention or delay of onset of type 2 diabetes in individuals at varying risk across the dysglycaemia continuum before overt diabetes becomes clinically manifest constitutes a leading objective of global disease prevention schemes. Pharmacological intervention has been suggested as a means to help prevent diabetes and reduce the global burden of this chronic condition. However, there is no credible evidence that early pharmacological intervention leads to long-term benefit in reducing diabetes-related complications or preventing early mortality, compared to treating people with diagnosed diabetes who have crossed the glycaemic threshold. In this review, we examine published evidence from trials using pharmacological agents to delay or prevent progression to diabetes. We also explore the benefit/risk impact of such therapies, safety issues and relevant off-target effects. Current evidence suggests none of the drugs currently available sustainably lower cumulative diabetes incidence, none provides a durable delay in diabetes diagnosis and none provides a convincing concomitant excess benefit for microvascular or macrovascular risk.

Original publication

DOI

10.1111/dom.12401

Type

Journal article

Journal

Diabetes Obes Metab

Publication Date

03/2015

Volume

17

Pages

231 - 244

Keywords

antidiabetic drug, clinical trial, type 2 diabetes, Adult, Chemoprevention, Diabetes Mellitus, Type 2, Disease Progression, Humans, Hypoglycemic Agents, Middle Aged, Randomized Controlled Trials as Topic, Risk Assessment