Question:
There's new evidence that glitazones and biguanides can prevent diabetes. I
know that glitazones are insulin potentiators at the muscle cell, and
therefore decrease effective insulin resistance. This results in less
insulin secretion by the pancreas. So perhaps the progression to diabetes
is delayed by the preservation of pancreatic function. Biguanides inhibit
gluconeogenesis in the liver, so they probably prevent diabetes by taking a
strain off of the pancreas by requiring less insulin production.
Anybody here have experience using these agents to prevent the progression
to diabetes? I'm considering using them in my practice for this. Some
questions arise:
When to start? Certainly when the person is diagnosed as having
pre-diabetes (either impaired glucose tolerance or impaired fasting
glucose). But what about in everyone with insulin resistance (defined for
example as a high c-peptide)?
When someone is taking one or both of these agents, but hasn't yet been
diagnosed as having diabetes, how do you make the diagnosis of diabetes?
You'd have to take them off the drugs and test them (e.g. 2-hour GTT), I
guess. Which brings up questions like: how often should people with
pre-diabetes be tested for diabetes, and how far ahead of time would you
have to take them off the drugs to make the test valid?
These are exciting times for diabetes management and prevention. Western
medicine is moving more in the direction of preventing diseases,
anticipating risk factors, keeping people healthy so they can live long,
quality lives.
Answer:
> There's new evidence that glitazones and biguanides can prevent diabetes.
An expensive way to prevent T2DM.
> I
> know that glitazones are insulin potentiators at the muscle cell, and
> therefore decrease effective insulin resistance. This results in less
> insulin secretion by the pancreas. So perhaps the progression to diabetes
> is delayed by the preservation of pancreatic function. Biguanides inhibit
> gluconeogenesis in the liver, so they probably prevent diabetes by taking a
> strain off of the pancreas by requiring less insulin production.
Perhaps.
> Anybody here have experience using these agents to prevent the progression
> to diabetes?
Given the price of these agents, it would be folks who are either wealthy or
have a lot of money saved up in their MSA.
> I'm considering using them in my practice for this. Some
> questions arise:
> When to start? Certainly when the person is diagnosed as having
> pre-diabetes (either impaired glucose tolerance or impaired fasting
> glucose). But what about in everyone with insulin resistance (defined for
> example as a high c-peptide)?
Far cheaper and with broader health benefits all-around (ie prevention of
cancer, heart disease, and stroke) would be to reach and maintain ideal body
weight. The 2PD approach which I advocate dovetails nicely with the diet
recommendations of the AHA, ADA, and ASH for the comorbities of heart disease,
diabetes, and hypertension respectively.
You can read about it on my web site at:
http://www.heartmdphd.com
