Should diabetes medications be used to prevent type 2 diabetes mellitus in patients with prediabetes?
Victor M. Montori: The problem of preventing prediabetes is that we are only looking at changes in the blood sugars from above the normal range but below diabetes range to above diabetes range. Patients do not feel that difference. For us to offer them diabetes medication just to move the sugar level so that they will not be diagnosed with diabetes creates a paradox – the paradox of not preventing the treatment of diabetes but only preventing the diagnosis. How are people better off with that is unclear to me. Diabetes drugs have not been shown to change the direction of the progression or the speed of progression of people in the biology of the condition. They just delay the diagnosis by changing the numbers.
I think the main focus instead of being, “How do we treat clinically those people at risk of diabetes using drugs?” is, “How do we look at our societies that are producing so many people with elevated blood sugars and obesity and how do we change the conditions of our society so that we have fewer patients and fewer cases?” I think that is an effort that is much more valuable than giving people drugs.