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

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Juan Pablo Domecq1, Gabriela Prutsky1, Tarig Elraiyah1,2

  • 1Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota.

The Journal of Clinical Endocrinology and Metabolism
|August 1, 2019
PubMed
Abstract

Insights

Certain medications can lower or raise the risk of developing type 2 diabetes mellitus (T2DM). Further research is needed to confirm if these effects are lasting and clinically significant for patients.

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.

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