Waking up from the DREAM of preventing diabetes with drugs

Waking up from the DREAM of preventing diabetes with drugs

The authors of this “Analysis” article discuss the research investigating whether drugs can reduce an individual’s risk of developing diabetes. In particular, they note that the recent DREAM trial found rosiglitazone decreased the risk of diabetes in people at risk and this has led to the promotion of rosiglitazone for the prevention of diabetes. However, they argue that strategies such as this “will bring harms and additional costs while the benefits for patients remain questionable.”

The following topics are discussed in the article:

• Preventing diabetes
• Effectiveness of drugs
• Use of a composite end point
• Are patients better off taking pills to prevent diabetes?
• Downsides of taking pills to prevent diabetes
• Benefits of diabetes prevention with glitazones

The authors conclude, “Because of the risk of harming people with no or minimal symptoms, the threshold for use of drugs in otherwise healthy people must be set high. To get the required data for rosiglitazone requires large and long randomised controlled trials measuring its effect on outcomes important to patients and use of healthcare resources. 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 serum glucose, increased burden of disease labelling, serious adverse effects, increased economic burden, and the availability of effective and less costly lifestyle measures”.

The main summary points (taken directly from the article) are provided below:

• Lifestyle changes and certain drugs are effective in preventing the diagnosis of diabetes
• No trial has shown that prevention with drugs improves outcomes important to patients
• Lifestyle changes are equally effective, much safer, and cheaper
• Clinical use of glitazones for prevention cannot be justified

Br Med J 2007; 334: 882-4 (link to extract);
BBC News report ( Anti-diabetes pills 'unjustified')