Michael Hochman, MD
Michael Hochman, MD, MPH, associate professor of clinical medicine at Keck School of Medicine and director of Gehr Family Center for Health Systems Science and Innovation at University of Southern California, Los Angeles.
Are pharmaceuticals the answer to America’s diabetes problem? One group of diabetes researchers recently reported on a novel approach—give people with prediabetes, those who are close to developing full-blown diabetes, three different drugs, including one that needs to be self-injected as often as twice a day.
It sounds extreme, but it worked. In the study, published in The Lancet, 81 overweight participants took the diabetes drugs metformin, pioglitazone (Actos) and a GLP-1 receptor agonist (Byetta, Victoza and others). On average, they were treated for 32 months. None of them got diabetes. In contrast, 11% of those in the study’s “lifestyle only” group, who were given diabetes-prevention advice on diet, weight loss and exercise and followed for 32 months, on average, developed diabetes.
So is lifestyle a failure? Don’t jump to conclusions from this study. Some of the people in the lifestyle group lost weight, but others gained weight. And losing weight if you are too heavy is a linchpin of preventing diabetes.
Maybe changing your diet, exercising and therefore losing weight—and keeping it off—is hard. But taking three medications for the rest of your life has plenty of downsides. Metformin often causes gastrointestinal problems…pioglitazone is associated with fluid retention and heart failure…and the GLP-1 medications may trigger nausea and headaches.
And the lifestyle changes above give you benefits well beyond keeping your blood sugar “number” down. They help prevent heart disease, stroke and other “complications” of prediabetes. It’s good that we have the prediabetes drugs for people who need them. But it’s better to improve our health ourselves and not have to take them.
