Abstract
Prediabetes, a high-risk state for future development of diabetes, is prevalent globally.
Abnormalities in the incretin axis are important in the progression of B-cell failure
in type 2 diabetes. Incretin based therapy was found to improve B cell mass and glycaemic
control in addition to having multiple beneficial effects on the systolic and diastolic
blood pressure, weight loss in addition to their other beneficial effects on the liver
and cardiovascular system. In prediabetes, several well-designed preventive trials
have shown that lifestyle and pharmacologic interventions such as metformin, thiazolidinediones
(TZD), acarbose and, nateglinide and orlistat, are effective in reducing diabetes
development. In recent small studies, incretin based therapy (DPP IV inhibitors and
GLP-1 agonists) have also been extended to patients with prediabetes since it was
shown to better preserve B-cell function and mass in animal studies and in clinical
trials and it was also shown to help maintain good long term metabolic control. Because
of the limited studies and clinical experience, their side effects and costs currently
guidelines do not recommend incretin-based therapies as an option for treatment in
patients with prediabetes. With future clinical trials and studies they may be recommended
for patients with impaired fasting glucose or impaired glucose tolerance.
Keywords
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Article info
Publication history
Published online: March 24, 2014
Accepted:
February 24,
2014
Received in revised form:
February 20,
2014
Received:
October 29,
2013
Identification
Copyright
© 2014 Primary Care Diabetes Europe. Published by Elsevier Inc. All rights reserved.
