Risk factors

Medications recommended for prediabetes – but not first line

Oral hypoglycaemic drugs and weight-loss medications are recommended for people with prediabetes in new Australian guidance, but lifestyle modification measures remain the first line option.

A comprehensive new Position Statement on Screening and Management of Prediabetes in Adults in Primary Care in Australia has provided the evidence and recommendations for what is hoped to be consistent advice from different members of the multidisciplinary team.

The statement represents the collective view of the Australian Diabetes Society (ADS), the Australian Diabetes Educators Association (ADEA), the Dietitians Association of Australia (DAA), Exercise and Sports Science Australia (ESSA) and Pharmaceutical Society of Australia (PSA).

While the statement is a long overdue update of a 2007 document, the management advice – emphasising the role of intensive lifestyle modification to prevent or delay the onset of type 2 diabetes – remains largely the same.

“Lifestyle strategies should include weight reduction, healthy eating, regular physical activity and reducing sedentary behaviour as appropriate. Weight loss of 5-10% has been shown to halve the risk of progression to type 2 diabetes,” it says in the summary of recommendations.

Co-author and exercise physiologist Dr Brett Gordon, told the limbic there was some evidence to support the use of weight loss medications and oral anti-glycaemic medications such as metformin.

“What we’re reasonably clear on is that medications shouldn’t be the first line of treatment for prediabetes and that all of the other lifestyle factors should be considered as primary interventions. But when those interventions aren’t sufficient on their own then I think it is prudent that we start to think about supplementing that or augmenting that with some pharmacological treatments.”

The statement recommended people with prediabetes have annual retesting of their HbA1c.

“Other health outcomes, such as weight and blood pressure, can be reassessed more regularly to assess the efficacy of interventions and any disease progression,” the recommendations said.

Dr Gordon said there had been some discussion around appropriate HbA1c cut-off values to identify prediabetes with the final recommendation of 6.1-6.4%.

But there was more work required to better understand prediabetes and the best way to treat it.

“The key thing is that there may be differences in how people need to be treated depending on whether they have impaired fasting glucose (IFG) as opposed to impaired glucose tolerance (IGT) for example, and that’s because the evidence for treatment IFG is far less clear than what it is for treating people with IGT,” he said.

Associate Professor Sof Andrikopoulos, CEO of the ADS, told the limbic he agreed there was a need for more research in understanding prediabetes, the progression to diabetes, the number of people affected, and for example, possible ethnic differences.

“We still don’t know what type of exercises are better than others and how to tailor the lifestyle modification to a particular prediabetes population.”

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