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      Olivia J Phung PharmD; William L Baker PharmD BCPS (AQ CV); Vanita Tongbram MBBS MPH; Adarsh Bhardwaj MD; Craig I Coleman PharmD

      Disclosures

      reverses diabetes type 2 hands (πŸ‘ cookbook) | reverses diabetes type 2 quotehow to reverses diabetes type 2 for The Annals of Pharmacotherapy. 2012;46(4):469-476. 

      In This Article

      reverses diabetes type 2 normal (⭐️ can drink alcohol) | reverses diabetes type 2 graphhow to reverses diabetes type 2 for Abstract and Introduction

      Abstract

      Background: Impaired glucose tolerance, impaired fasting glucose, and elevated hemoglobin A1c are intermediate stages, considered prediabetes, a precursor to overt type 2 diabetes mellitus. Prediabetes is associated with increased risk for cardiovascular disease, independent of diabetes development. Data have shown that various oral antidiabetic drugs can help people regress from prediabetes to normoglycemia.
      Objective: To evaluate the efficacy of oral antidiabetic drugs in promoting regression from prediabetes to normoglycemia.
      Methods: MEDLINE (1950-November 2011), EMBASE (1990-November 2011), and Cochrane Central Register of Controlled Trials (indexed September 2011) were systematically searched. A manual search of references from reports of clinical trials and review articles was performed to identify additional relevant studies. Randomized controlled trials 12 weeks or more in duration evaluating any of the oral antidiabetic drugs and studying regression from prediabetes to normoglycemia were included. A random-effects model was used to calculate pooled odds ratios with 95% confidence intervals.
      Results: Thirteen studies (N = 11,600 participants) were included in the metaanalysis. Use of oral antidiabetic drugs in prediabetic patients was shown to double the odds of achieving normoglycemia compared to controls (OR 2.03, 95% CI 1.54 to 2.67). When individual classes of oral antidiabetic drugs were evaluated, use of thiazolidinediones (OR 2.33, 95% CI 1.93 to 2.81) and Ξ±-glucosidase inhibitors (OR 2.02, 95% CI for 1 last update 29 May 2020 1.26 to 3.24) was associated with significantly increased odds. However, biguanides (OR 2.04) and sulfonylureas (OR 1.84) failed to reach statistical significance (p = 0.06 and p = 0.39, respectively).
      Conclusions: In patients with prediabetes, oral antidiabetic drugs were associated with increased odds of regression to normoglycemia versus placebo/control. Only thiazolidinediones and Ξ±-glucosidase inhibitors provided a statistically significant increase in odds of regressing to normoglycemia. Background: Impaired glucose tolerance, impaired fasting glucose, and elevated hemoglobin A1c are intermediate stages, considered prediabetes, a precursor to overt type 2 diabetes mellitus. Prediabetes is associated with increased risk for cardiovascular disease, independent of diabetes development. Data have shown that various oral antidiabetic drugs can help people regress from prediabetes to normoglycemia.
      Objective: To evaluate the efficacy of oral antidiabetic drugs in promoting regression from prediabetes to normoglycemia.
      Methods: MEDLINE (1950-November 2011), EMBASE (1990-November 2011), and Cochrane Central Register of Controlled Trials (indexed September 2011) were systematically searched. A manual search of references from reports of clinical trials and review articles was performed to identify additional relevant studies. Randomized controlled trials 12 weeks or more in duration evaluating any of the oral antidiabetic drugs and studying regression from prediabetes to normoglycemia were included. A random-effects model was used to calculate pooled odds ratios with 95% confidence intervals.
      Results: Thirteen studies (N = 11,600 participants) were included in the metaanalysis. Use of oral antidiabetic drugs in prediabetic patients was shown to double the odds of achieving normoglycemia compared to controls (OR 2.03, 95% CI 1.54 to 2.67). When individual classes of oral antidiabetic drugs were evaluated, use of thiazolidinediones (OR 2.33, 95% CI 1.93 to 2.81) and Ξ±-glucosidase inhibitors (OR 2.02, 95% CI 1.26 to 3.24) was associated with significantly increased odds. However, biguanides (OR 2.04) and sulfonylureas (OR 1.84) failed to reach statistical significance (p = 0.06 and p = 0.39, respectively).
      Conclusions: In patients with prediabetes, oral antidiabetic drugs were associated with increased odds of regression to normoglycemia versus placebo/control. Only thiazolidinediones and Ξ±-glucosidase inhibitors provided a statistically significant increase in odds of regressing to normoglycemia.

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      Impaired glucose tolerance (IGT), impaired for 1 last update 29 May 2020 fasting glucose (IFG), or elevated hemoglobin A1c(A1C) are intermediate stages between normoglycemia and overt type 2 diabetes mellitus (T2DM). These stages are often referred to as prediabetes.[1,2] Criteria for diagnosis of prediabetes are set by the World Health Organization and the American Diabetes Association (ADA)[2–7] and are based on blood glucose levels after oral glucose tolerance test or after fasting or an A1C test. Definitions have changed over the years; for example, the most recent ADA criteria for prediabetes include elevated A1C of 5.7–6.4%, IGT defined by 2-hour plasma glucose level following a 75-g oral glucose tolerance test of 140–199 mg/dL, or IFG defined by fasting plasma glucose level of 100–125 mg/dL.[2] These prediabetic states are associated with increased risk of progression to T2DM[8] and its associated macro- and microvascular complications.[1] Patients with prediabetes are at increased risk of developing cardiovascular disease, independent of diabetes development.[8,9] Moreover, studies have also found that cardiovascular mortality and all-cause mortality are higher in people with prediabetes than in those with normoglycemia.[1] Impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or elevated hemoglobin A1c(A1C) are intermediate stages between normoglycemia and overt type 2 diabetes mellitus (T2DM). These stages are often referred to as prediabetes.[1,2] Criteria for diagnosis of prediabetes are set by the World Health Organization and the American Diabetes Association (ADA)[2–7] and are based on blood glucose levels after oral glucose tolerance test or after fasting or an A1C test. Definitions have changed over the years; for example, the most recent ADA criteria for prediabetes include elevated A1C of 5.7–6.4%, IGT defined by 2-hour plasma glucose level following a 75-g oral glucose tolerance test of 140–199 mg/dL, or IFG defined by fasting plasma glucose level of 100–125 mg/dL.[2] These prediabetic states are associated with increased risk of progression to T2DM[8] and its associated macro- and microvascular complications.[1] Patients with prediabetes are at increased risk of developing cardiovascular disease, independent of diabetes development.[8,9] Moreover, studies have also found that cardiovascular mortality and all-cause mortality are higher in people with prediabetes than in those with normoglycemia.[1]

      Active interventions such as lifestyle modification or pharmacologic therapy are attractive options to reduce some of the risks associated with prediabetes. Current guidelines suggest structured lifestyle modification with increased physical activity aimed at losing 5–10% of body weight as the cornerstone of treatment.[2] However, many patients cannot adhere to these measures or need additional assistance to achieve normoglycemia. Data from randomized controlled trials (RCTs) have shown that various oral antidiabetic drugs can help patients regress from prediabetes to normoglycemia.[10–22] The purpose of this meta-analysis is to synthesize the evidence regarding the efficacy of oral antidiabetic drugs in promoting regression from prediabetes to normoglycemia.

      reverses diabetes type 2 zhongwen (πŸ”₯ fasting) | reverses diabetes type 2 blood testhow to reverses diabetes type 2 for The Annals of Pharmacotherapy. 2012;46(4):469-476. Β© 2012  Harvey Whitney Books Company

      Tables
      Table 1.  Summary of Trial Characteristics and End Points
      Study Patients (N), Duration (y) Inclusion Criteria Definition of Prediabetes and Normoglycemiaa Population, meanb Concurrent Lifestyle Modification Treatment Regression to NGT, n/N (%) Jadad Scorec
      ACT NOW (2011) 10 N = 602 2 IGT WHO 1999 Age: 52 Male (%): 58 BMI: 34 Weight: NR (mean of the study population) All pts. given 30 minutes of instruction by a dietician, with goals emphasizing reduced caloric intake, decreased fat intake, and walking 30 minutes per day for 4–5 days per week Pioglitazone 45 mg daily Placebo 127/303 (42) 84/299 (28) 5 (2, 2, 1)
      Kawamori (2009) 11 N = 1780 0.93 (mean) IGT WHO 1999 Age: 56, 56 Male (%): 60, 60 BMI: 26, 26 Weight: NR Advice on appropriate nutrition and exercise programs Voglibose 0.2 mg 3 times daily Placebo 599/897 (67) 454/883 (51) 5 (2, 2, 1)
      DREAM (2006) 12 N = 8269 3 IGT or IFG ADA 2003 Age: 55, 55 Male (%): 42, 40 BMI: 31, 32 Weight: 85, 85 Advice on importance of healthy diet and lifestyle and adherence was assessed and reinforced Rosiglitazone 8 mg once daily Placebo 1016/2635 (39) 540/2634 (21) 5 (2, 2, 1)
      Eriksson (2006) 13 N = 33 0.5 IGT WHO 1999 Age: 59, 54 Male (%): 12, 41 BMI: 28, 29 Weight: NR None Glipizide 2.5 mg once daily Placebo 9/16 (56) 7/17 (41) 4 (1, 2, 1)
      Hung (2005) 14 N = 30 0.25 IGT ADA 1997 Age: 55, 55 Male (%): 47, 40 BMI: 25, 24 Weight: NR Advice to maintain stable body weight and diet Rosiglitazone 4 mg daily Placebo 5/15 (33) 2/15 (13) 1 (1, 0, 0)
      Bennett (2004) 15 N = 18 0.25 IGT WHO 1985 Age: 63, 57 Male (%): 56, 56 BMI: 30, 29 Weight: 80, 82 Advice to follow weight-maintaining diet throughout the study, to continue their usual patterns, and to avoid strenuous exercise for 24 hours before each study and during ambulatory blood pressure monitoring Rosiglitazone 4 mg twice daily Placebo 4/9 (44) 0/9 (0) 4 (1, 2, 1)
      Fang (2004) 16 N = 124 5 IGT WHO 1985 Age: 50, 50, 47 Male (%): 62, 59, 63 BMI: 25, 25, 25 Weight: NR Treatment groups received no advice Control group received education on diabetes prevention Acarbose 25–50 mg 3 times daily Metformin 125–250 mg 3 times daily Control 30/45 (67) 23/44 (52) 10/35 (29) 2 (2, 0, 0)
      DPP (2002) 17 N = 2155 2.8 (mean) IFG and IGT ADA 1997 Age: 51, 50 Male (%): 34, 31 BMI: 34, 34 Weight: 94, 94 Recommendations on diet, weight and exercise Metformin 850 mg twice daily Placebo 224/1073 (21) 201/1082 (19) 4 (2, 1, 1)
      STOP-NIDDM (2002) 18 N = 1368 3.3 (mean) IGT WHO 1985 Age: 54, 55 Male (%): 48, 50 BMI: 31, 31 Weight: 88, 87 Counseling on weight reduction, weight maintenance and diet Acarbose 100 mg 3 times daily Placebo 241/682 (35) 212/686 (31) 5 (2, 2, 1)
      Lehtovirta (2001) 19 N = 40 1 IGT WHO (NR) Age: 57, 59 Male (%): 70, 55 BMI: 30, 30 Weight: 91, 88 None Metformin 250 mg 3 times daily Placebo 8/20 (40) 6/20 (30) 2 (1, 1, 0)
      Li (2001) 20 N = 70 1 IGT WHO 1985 Age: 49, 50 Male (%): 73, 70 BMI: 26, 26 Weight: NR None Metformin 250 mg 3 times daily Placebo 28/33 (85) 19/37 (51) 3 (1, 1, 1)
      Wang (2000) 21 N = 60 1 IGT WHO 1985 Age: 64, 63 Male (%): 48, 47 BMI: 23, 21 Weight: NR Diet training to prevent diabetes Acarbose 50 mg 3 times daily Control 9/30 (30) 2/30 (6.7) 1 (1, 0, 0)
      Antonucci (1997) 22 N = 51 0.25 IGT WHO 1985 Age: 48, 47 Male (%): 12, 27 BMI: 33, 34 Weight: NR None Troglitazone 400 mg once daily Placebo 16/20 (80) 10/21 (48) 3 (1, 1, 1)

      ACT NOW = ACTos NOW for the Prevention of Diabetes; ADA = American Diabetes Association; BMI = body mass index; DPP = Diabetes Prevention Program; DREAM = Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication Trial; FBG = fasting blood glucose; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; NR = not reported; OGTT = oral glucose tolerance test; STOP-NIDDM = Study to Prevent Non-Insulin-Dependent Diabetes Mellitus Trial; WHO = World Health Organization.
      aWHO Criteria 1999: normal: FBG <110 mg/dL; IGT: FBG <126 mg/dL and OGTT 140–200 mg/dL; IFG: FBG 110–126 mg/dL and OGTT <140 mg/dL. WHO Criteria 1985: normal: not defined; IGT: FBG <140 mg/dL and OGTT 140–200 mg/dL; IFG: not defined. American Diabetes Association Criteria 2003: normal: FBG <110 mg/dL and OGTT <140 mg/dL; IGT: OGTT β‰₯140 mg/dL and <200 mg/dL, IFG: FBG β‰₯100–124 mg/dL. American Diabetes Association Criteria 1997: normal: FBG <110 mg/dL and OGTT <140 mg/dL; IGT: OGTT β‰₯140 mg/dL and <200 mg/dL, IFG: FBG β‰₯110 mg/dL and <126 mg/dL.
      bAge is reported in years and weight is reported in kilograms.
      cJadad score presented as overall score; subscores are for randomization (up to 2 points), double-blinding (up to 2 points), and description of withdrawals (up to 1 point).

      References
      Authors and Disclosures

      Authors and Disclosures

      Olivia J Phung

      PharmD Assistant Professor of Pharmacy Practice, College of Pharmacy, Western University of Health Sciences, Pomona, CA

      William L Baker
      PharmD BCPS (AQ CV) Assistant Professor, Schools of Pharmacy and Medicine, University of Connecticut, Storrs

      Vanita Tongbram
      MBBS MPH Research Associate, Hartford Hospital, Hartford, CT

      Adarsh Bhardwaj
      MD Cardiology Medicine Fellow, Danbury Hospital, Danbury, CT

      Craig I Coleman
      PharmD Associate Professor of Pharmacy Practice, School of Pharmacy, University of Connecticut

      Conflict of interest
      Drs. Phung and Coleman have received research funding from Takeda Pharmaceuticals North America, Inc., the manufacturer of an oral antidiabetic drug. This study was independently conducted and received no financial support.

      Correspondence
      Dr. Phung, [email protected]

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