Diabetes Trials Unit, University of Oxford, Churchill Hospital, Oxford, UK; Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Diabetes Obes Metab. 2015 Mar;17(3):231-44. doi: 10.1111/dom.12401. Epub 2014 Nov 27.
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.
在明显糖尿病临床表现之前，处于不同糖代谢异常连续体风险的个体中预防或延缓 2 型糖尿病的发生，是全球疾病预防计划的主要目标。有人提出药物干预是帮助预防糖尿病和减轻这种慢性疾病全球负担的一种手段。然而，与治疗已经跨过血糖阈值的诊断为糖尿病的患者相比，没有可信的证据表明早期药物干预在减少与糖尿病相关的并发症或预防早期死亡方面会带来长期益处。在这篇综述中，我们检查了使用药物来延缓或预防糖尿病进展的试验的已发表证据。我们还探讨了此类治疗的获益/风险影响、安全性问题和相关的非靶点效应。目前的证据表明，目前可用的药物都不能持续降低累积糖尿病发病率，没有一种药物能持久延缓糖尿病的诊断，也没有一种药物能为微血管或大血管风险带来令人信服的额外益处。
