Journal ArticleDOI
Pioglitazone for Diabetes Prevention in Impaired Glucose Tolerance
Ralph A. DeFronzo,Devjit Tripathy,Dawn C. Schwenke,Dawn C. Schwenke,Mary Ann Banerji,George A. Bray,Thomas A. Buchanan,Stephen Clement,Robert R. Henry,Howard N. Hodis,Abbas E. Kitabchi,Wendy J. Mack,Sunder Mudaliar,Robert E. Ratner,Kenneth C. Williams,Frankie B. Stentz,Nicolas Musi,Peter D. Reaven +17 more
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TLDR
As compared with placebo, pioglitazone reduced the risk of conversion of impaired glucose tolerance to type 2 diabetes mellitus by 72% but was associated with significant weight gain and edema.Abstract:
RESULTS Annual incidence rates for type 2 diabetes mellitus were 2.1% in the pioglitazone group and 7.6% in the placebo group, and the hazard ratio for conversion to diabetes in the pioglitazone group was 0.28 (95% confidence interval, 0.16 to 0.49; P<0.001). Conversion to normal glucose tolerance occurred in 48% of the patients in the pioglitazone group and 28% of those in the placebo group (P<0.001). Treatment with pioglitazone as compared with placebo was associated with significantly reduced levels of fasting glucose (a decrease of 11.7 mg per deciliter vs. 8.1 mg per deciliter [0.7 mmol per liter vs. 0.5 mmol per liter], P<0.001), 2-hour glucose (a decrease of 30.5 mg per deciliter vs. 15.6 mg per deciliter [1.6 mmol per liter vs. 0.9 mmol per liter], P<0.001), and HbA1c (a decrease of 0.04 percentage points vs. an increase of 0.20 percentage points, P<0.001). Pioglitazone therapy was also associated with a decrease in diastolic blood pressure (by 2.0 mm Hg vs. 0.0 mm Hg, P = 0.03), a reduced rate of carotid intima–media thickening (31.5%, P = 0.047), and a greater increase in the level of high-density lipoprotein cholesterol (by 7.35 mg per deciliter vs. 4.5 mg per deciliter [0.4 mmol per liter vs. 0.3 mmol per liter], P = 0.008). Weight gain was greater with pioglitazone than with placebo (3.9 kg vs. 0.77 kg, P<0.001), and edema was more frequent (12.9% vs. 6.4%, P = 0.007). CONCLUSIONS As compared with placebo, pioglitazone reduced the risk of conversion of impaired glucose tolerance to type 2 diabetes mellitus by 72% but was associated with significant weight gain and edema. (Funded by Takeda Pharmaceuticals and others; ClinicalTrials.gov number, NCT00220961.)read more
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Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association
Walter N. Kernan,Bruce Ovbiagele,Henry R. Black,Dawn M. Bravata,Marc I. Chimowitz,Michael D. Ezekowitz,Margaret C. Fang,Marc Fisher,Karen L. Furie,Donald V. Heck,S. Claiborne Johnston,Scott E. Kasner,Steven J. Kittner,Pamela H. Mitchell,Michael W. Rich,DeJuran Richardson,Lee H. Schwamm,John A. Wilson +17 more
TL;DR: In this paper, the authors provided evidence-based recommendations for the prevention of future stroke among survivors of ischemic stroke or transient ischemi-chemic attack, including the control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke.
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Prediabetes: a high-risk state for diabetes development
Adam G. Tabak,Adam G. Tabak,Christian Herder,Wolfgang Rathmann,Eric J. Brunner,Mika Kivimäki +5 more
TL;DR: Observational evidence shows associations between prediabetes and early forms of nephropathy, chronic kidney disease, small fibre neuropathy, diabetic retinopathy, and increased risk of macrovascular disease, while accumulating data also show potential benefits from pharmacotherapy.
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Type 2 diabetes mellitus.
Ralph A. DeFronzo,Ele Ferrannini,Leif Groop,Robert R. Henry,William H. Herman,Jens J. Holst,Frank B. Hu,C. Ronald Kahn,Itamar Raz,Gerald I. Shulman,Donald C. Simonson,Marcia A. Testa,Ram Weiss +12 more
TL;DR: The greatest need is for agents that enhance insulin sensitivity, halt the progressive pancreatic β-cell failure that is characteristic of T2DM and prevent or reverse the microvascular complications.
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Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future
TL;DR: More effective therapies to slow progressive loss of β-cell function are needed and additional long-term studies of drugs and bariatric surgery are needed to identify new ways to prevent and treat type 2 diabetes and thereby reduce the harmful effects of this disease.
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American association of clinical endocrinologists and american college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity.
W. Timothy Garvey,Jeffrey I. Mechanick,Elise M. Brett,Alan J. Garber,Daniel L. Hurley,Ania M. Jastreboff,Karl Nadolsky,Rachel Pessah-Pollack,Raymond A Plodkowski +8 more
TL;DR: The final recommendations recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complications and adiposity to improve overall health and quality of life.
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