Rochester: Taking prescription drugs to prevent diabetes cannot be justified, say US researchers in this weeks British Medical Journal.
They argue that lifestyle changes, such as modest weight loss and physical activity, are equally effective much safer, and cheaper.
Diabetes affects about 4% of the world population and is associated with high financial and human costs. This makes preventing diabetes a public health priority.
A recent trial showed that the drug rosiglitazone reduced the risk of diabetes in people at risk. The results have prompted aggressive promotion of rosiglitazone as a preventive therapy. But Professor Victor Montori and colleagues warn that this strategy will bring harms and additional costs while the benefits for patients remain questionable.
Several trials have assessed the ability of drugs to prevent diabetes, but none have shown that prevention with drugs improves outcomes important to patients. Evidence is also emerging of serious side effects of glitazones.
If clinicians offer patients glitazones to prevent diabetes, they are offering certain inconvenience, cost, and risk for largely speculative benefit, say the authors. Lifestyle changes are at least as effective as glitazones and can be implemented considerably more cheaply.
They conclude: Clinical use of glitazones to prevent diabetes is, at present, impossible to justify because of unproved benefit on patient important outcomes or lasting effect on blood glucose levels, increased burden of disease labelling, serious adverse effects, increased economic burden, and availability of effective, less costly lifestyle measures.