June 20, 2012Volume 7 - Issue 25

DynaMed Weekly Update

For the week ending June 15, 2012

Last week 604 articles were evaluated via DynaMed's Systematic Literature Surveillance and 237 were added to DynaMed content.  

 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Return to Normoglycemia from Prediabetes Associated with Reduced Risk of Developing Diabetes

 

In the Diabetes Prevention Program (DPP) trial, both lifestyle modification and metformin treatment were associated with reduced progression to diabetes in patients with prediabetes (N Engl J Med 2002 Feb 7;346(6):393), and several other trials have shown similar results. A large cohort of patients from the DPP trial had continued follow-up for diabetes outcomes in the DPP Outcome Study. A newly published analysis investigated the association between regression to normoglycemia and risk of progression to diabetes in 1,990 patients from this cohort who had not progressed by the end of the original DPP trial. Of these patients, 37% had been randomized to lifestyle modification, 32.5% to metformin, and 30.5% to placebo. Median follow-up was 3.2 years during the DPP trial and 7.5 years during the cohort study. All patients were assessed yearly for glycemic control by oral glucose tolerance tests.

 

Normoglycemia was defined as fasting plasma glucose < 5.6 mmol/L (100 mg/dL) and 2-hour plasma glucose < 7.8 mmol/L (140 mg/dL). Prediabetes was defined as fasting plasma glucose 5.6-6.9 mmol/L (100-124 mg/dL) and/or 2-hour plasma glucose of 7.8-11 mmol/L (140-198 mg/dL). Higher levels indicated progression to diabetes.

 

During the DPP trial, 894 patients (45%) had at least 1 glucose tolerance test on which they regressed to the normoglycemic range (including 53.5% of the lifestyle modification group, 42.3% of metformin group, and 37.2% of placebo group). The remaining 1,096 patients had consistent tests indicating prediabetes during the trial.

 

Regression to normoglycemia on at least 1 test during the DPP trial was associated with reduced risk of progression to diabetes compared to consistent prediabetes (hazard ratio 0.44, 95% CI 0.37-0.55). There were no significant differences among the 3 randomized groups in the relationship between regression to normoglycemia and progression to diabetes. Diabetes risk was reduced regardless of the manner in which normoglycemia was achieved, even with placebo.

 

Subgroup analyses were performed in patients who failed to achieve normoglycemia during the trial to compare the effects of the randomized treatments on later glycemic control during observational follow-up. Of note, failure to normalize glucose with lifestyle modification was associated with decreased likelihood of later regression to normoglycemia (odds ratio 0.59, 95% CI 0.42-0.82) and increased risk of progression to diabetes compared to placebo (hazard ratio 1.31, 95% CI 1.03-1.68). There were no significant differences in regression to normoglycemia or progression to diabetes comparing metformin vs. placebo (Lancet 2012 Jun 8 early online). These data suggest that patients who are diagnosed with prediabetes can be stratified regarding their risk for progression to diabetes by whether or not they subsequently have normal values on glucose tolerance testing.

 

For more information, see the Prediabetes and Risk factors for diabetes mellitus type 2 topics in DynaMed.

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Call for Peer Reviewers

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Diabetes mellitus type 2 screening 

Dietary considerations for patients with type 2 diabetes

 

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information
 
CREDITS
Physicians: 0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
 
Release Date: June 20, 2012

Expiration Date: June 20, 2013
Estimated Completion Time:

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Alan Ehrlich, MD- Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

 

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company
  


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