Pharmacological intervention: the antidiabetic approach

Area of Science:

• Endocrinology
• Metabolic Disorders
• Pharmacology

Background:

• Impaired glucose tolerance (IGT) can progress to non-insulin-dependent diabetes mellitus (NIDDM).
• The long-term effects of antihyperglycemic pharmacotherapy on NIDDM development and macrovascular complications in IGT subjects are not fully understood.

Purpose of the Study:

• To summarize results from long-term antihyperglycemic interventions (> 4 years) investigating their impact on NIDDM progression and macrovascular disease in IGT patients.
• To evaluate the efficacy of specific drugs, such as tolbutamide and phenformin, in managing IGT and its associated risks.

Main Methods:

• Review of multiple long-term (> 4 years) clinical studies involving antihyperglycemic interventions.
• Analysis of data from American, Swedish, and British cohorts examining drug effects on glucose tolerance, NIDDM development, and macrovascular outcomes.
• Inclusion of studies with interventions like tolbutamide and phenformin, alongside control and diet groups.

Main Results:

• Tolbutamide showed potential in improving glucose tolerance and survival in some studies.
• Phenformin did not influence glucose level deterioration in one study.
• A Swedish study indicated tolbutamide significantly reduced NIDDM development, blood pressure, triglyceride, and cholesterol levels, with fewer macrovascular complications.
• Long-term follow-up suggested a lower mortality rate with tolbutamide treatment.

Conclusions:

• Insulin-releasing drugs, particularly tolbutamide, may play a role in delaying NIDDM progression and mitigating macrovascular disease in individuals with IGT.
• Further extensive research is required to definitively establish the benefits and risks of these pharmacotherapies.