Trials That Matter: Rosiglitazone, Ramipril, and the Prevention of Type 2 Diabetes

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Editorials20 March 2007Trials That Matter: Rosiglitazone, Ramipril, and the Prevention of Type 2 DiabetesDavid M. Nathan, MD and Michael Berkwits, MSCE, Deputy EditorDavid M. Nathan, MDFrom the Massachusetts General Hospital Diabetes Unit, Boston, MA 02114, and American College of Physicians, Philadelphia, PA 19106.Search for more papers by this author and Michael Berkwits, MSCE, Deputy EditorFrom the Massachusetts General Hospital Diabetes Unit, Boston, MA 02114, and American College of Physicians, Philadelphia, PA 19106.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-6-200703200-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Despite the growing number of options for treating type 2 diabetes, clinicians wanting to prevent the disease in high-risk patients have few good choices. Lifestyle changes that lead to weight loss can prevent diabetes (1, 2) but are difficult to adopt and maintain (3). Drugs used to treat diabetes are often expensive, and testing has only recently begun on their efficacy as primary preventive agents. Two large trials in 2002 showed that metformin (1) and acarbose (4) effectively prevent diabetes in participants with impaired glucose tolerance, but neither drug has been approved by the U.S. Food and Drug Administration (FDA) ...References1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. [PMID: 11832527] CrossrefMedlineGoogle Scholar2. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343-50. [PMID: 11333990] CrossrefMedlineGoogle Scholar3. Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J. Long-term non-pharmacological weight loss interventions for adults with prediabetes. Cochrane Database Syst Rev. 2005;:CD005270. [PMID: 15846748] MedlineGoogle Scholar4. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M, et al. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002;359:2072-7. [PMID: 12086760] CrossrefMedlineGoogle Scholar5. Knowler WC, Hamman RF, Edelstein SL, Barrett-Connor E, Ehrmann DA, Walker EA, et al. Prevention of type 2 diabetes with troglitazone in the Diabetes Prevention Program. Diabetes. 2005;54:1150-6. [PMID: 15793255] CrossrefMedlineGoogle Scholar6. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, et al. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women. Diabetes. 2002;51:2796-803. [PMID: 12196473] CrossrefMedlineGoogle Scholar7. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342:145-53. [PMID: 10639539] CrossrefMedlineGoogle Scholar8. Yusuf S, Gerstein H, Hoogwerf B, Pogue J, Bosch J, Wolffenbuttel BH, et al. Ramipril and the development of diabetes. JAMA. 2001;286:1882-5. [PMID: 11597291] CrossrefMedlineGoogle Scholar9. Julius S, Kjeldsen SE, Weber M, Brunner HR, Ekman S, Hansson L, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet. 2004;363:2022-31. [PMID: 15207952] CrossrefMedlineGoogle Scholar10. Gerstein HC, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, et al. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet. 2006;368:1096-105. [PMID: 16997664] CrossrefMedlineGoogle Scholar11. Bosch J, Yusuf S, Gerstein HC, Pogue J, Sheridan P, Dagenais S, et al. Effect of ramipril on the incidence of diabetes. N Engl J Med. 2006;355:1551-62. [PMID: 16980380] CrossrefMedlineGoogle Scholar12. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet. 2005;366:1279-89. [PMID: 16214598] CrossrefMedlineGoogle Scholar13. Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368:1673-9. [PMID: 17098085] CrossrefMedlineGoogle Scholar14. National Diabetes Surveillance System. Atlanta, GA: C