Pioglitazone reduced risk of type 2 diabetes by 72% vs placebo hr 28; 95% ci 16 49

Pioglitazone reduced risk of type 2 diabetes by 72% vs. placebo (HR 0.28; 95% CI 0.16–0.49 P<0.001)

• Pioglitazone reduced risk of type 2 diabetes by 72% vs. placebo (HR 0.28; 95% CI 0.16–0.49 P<0.001)

• Conversion to normal glucose tolerance: 48% of patients with pioglitazone vs 28% with placebo (P<0.001)

• Pioglitazone reduced fasting glucose, 2-hour glucose, HbA1c

• Weight gain, edema observed in the pioglitazone arm

Brief (1-2 week) drug washout study at end of Diabetes Prevention Program trial

• Brief (1-2 week) drug washout study at end of Diabetes Prevention Program trial

• After washout, diabetes was more frequently diagnosed in metformin vs. placebo (1.49; 0.93, 2.38; P=0.098)

• DPP primary analysis: metformin decreased diabetes risk by 31%

• Washout: 26% accounted for by pharmacological effect of metformin

• Postwashout: diabetes reduced by 25%

We must identify patients at highest risk (prediabetes)

• We must identify patients at highest risk (prediabetes)

• Modest lifestyle changes are most effective

• Sustain interventions

• Increase opportunities for community programs to support prevention

• Delaying or preventing type 2 diabetes is cost-effective and will help turn the tide on the diabetes epidemic

• “Health-taxes” for improving adherence to healthy lifestyle or reducing calorie intake might be considered