Medications Affecting the Biochemical Conversion to Type 2 Diabetes: A Systematic Review and Meta-Analysis

Area of Science:

• Pharmacology
• Endocrinology
• Clinical Trials

Background:

• The impact of pharmacological interventions on type 2 diabetes mellitus (T2DM) risk in susceptible individuals is not fully understood.
• Clarifying drug effects on T2DM conversion is crucial for preventative strategies.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) assessing drug effects on biochemical conversion to T2DM.
• To identify medications that may alter T2DM risk in at-risk populations.

Main Methods:

• Comprehensive literature search of major databases (MEDLINE, Embase, Cochrane, Scopus) up to August 2017.
• Inclusion of 43 RCTs involving 192,156 participants.
• Analysis of drugs suspected to modify T2DM conversion risk.

Main Results:

• Alpha-glucosidase inhibitors, ACE inhibitors, ARBs, metformin, orlistat, phentermine/topiramate, and pioglitazone significantly reduced T2DM risk.
• Statins and nateglinide were associated with an increased risk of T2DM conversion.
• Limited evidence exists for sulfonylureas, GLP-1 RAs, DPP-4 inhibitors, and SGLT-2 inhibitors; most trials lacked withdrawal periods.

Conclusions:

• Several drug classes influence the risk of biochemical conversion to T2DM.
• The persistence and clinical relevance of these drug-induced risk modifications require further investigation.
• Future research should prioritize patient-important outcomes, mortality, and cardiovascular disease prevention over solely biochemical T2DM conversion.