BMJ  2007;334:882-884 (28 April), doi:10.1136/bmj.39169.447488.94

Analysis

Waking up from the DREAM of preventing diabetes with drugs

¹ Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA, ² Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, ³ CLARITY Research Group, Department of Biostatistics and Clinical Epidemiology and Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

The current epidemic of diabetes makes a drug to prevent it attractive. But despite promotion of recent research evidence, Victor Montori, William Isley, and Gordon Guyatt argue that we are not there yet

The first 150 words of the full text of this article appear below.

Diabetes affects about 4% of the world population^{1 2} and is associated with important costs, both in financial and human terms.³ The high prevalence, increasing incidence, and associated costs makes preventing diabetes a public health priority. The diabetes reduction assessment with ramipril and rosiglitazone medication (DREAM) trial recently showed that rosiglitazone reduced the risk of diabetes in people at risk.⁴ The results have prompted aggressive marketing of rosiglitazone as a preventive therapy; some clinicians are already responding to this initiative. We argue that the strategy will bring harms and additional costs while the benefits for patients remain questionable.

Preventing diabetes

Several randomised trials have shown that modest weight loss and physical activity can greatly reduce the risk of diabetes.^{5 6 7} The Diabetes Prevention Program documented a 58% relative risk reduction (confidence interval 48% to 66%) in high risk individuals⁵; other trials have shown similar results.^{6 7}

Nevertheless, the possibility of preventing diabetes with drugs . . . [Full text of this article]

Effectiveness of drugs

Evidence for drug prevention of diabetes
Metformin
Troglitazone (no longer available)
Angiotensin converting enzyme inhibitors, angiotensin receptor blockers

Use of a composite end point

Are patients better off taking pills to prevent diabetes?

Downsides of taking pills to prevent diabetes

Benefits of diabetes prevention with glitazones

Conclusion

Summary points

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This article has been cited by other articles:

• Starfield, B, Hyde, J, Gervas, J, Heath, I (2008). The concept of prevention: a good idea gone astray?. J. Epidemiol. Community Health 62: 580-583 [Abstract] [Full text]  
• Goyder, E. C (2008). Screening for and prevention of type 2 diabetes. BMJ 336: 1140-1141 [Full text]  
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• Psaty, B. M., Furberg, C. D. (2007). The Record on Rosiglitazone and the Risk of Myocardial Infarction. NEJM 357: 67-69 [Full text]  

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