What are the preventive drugs for diabetes?

Currently, no drugs specifically used to prevent diabetes have been approved in China. Clinical studies have confirmed that they may reduce the risk of type 2 diabetes, mainly metformin, acarbose, and the popular GLP-1 receptor agonist preparations in recent years, such as liraglutide, semaglutide, etc.

I met a 32-year-old Internet programmer at the outpatient clinic before. He stayed up late and ate takeaways all the time. The physical examination showed that his fasting blood sugar was 6.4mmol/L. His blood sugar level after the 2-hour glucose tolerance test reached 9.3mmol/L. He was already in the pre-diabetes stage and his BMI was almost 29. , he said that he really couldn't find time to exercise, and he couldn't control his desire to drink milk tea. After a comprehensive evaluation, the doctor prescribed a small dose of metformin and asked him to adjust his diet as much as possible. After half a year, he checked again and found that his glucose tolerance had returned to the normal range and his weight was more than 5 pounds lighter.

However, there has been a lot of controversy about preventive medication. Some experts believe that as long as they persist in lifestyle intervention, more than 80% of people with prediabetes can return to normal without the need for medication. After all, any medication has potential adverse reactions, and there is no need to take additional risks for prevention.； There is also a view that for people with poor self-control and multiple high-risk factors such as high blood pressure, hyperlipidemia, and obesity, early medication intervention can significantly reduce the probability of subsequent development of diabetes, and the benefits outweigh the risks. Take GLP-1 preparations as an example. At present, diabetes prevention has not been included in its indications in China. Only some European and American countries recommend its use to high-risk pre-diabetic people. In China, it is usually when doctors assess that the benefits far outweigh the risks, they will recommend off-label use for this group of people.

Many people's first reaction when they are diagnosed with high blood sugar is to ask whether they can take medicine to prevent it. In fact, it is not suitable for everyone. For example, people who are thin and have abnormal liver and kidney function may be at risk of lactic acidosis if they take metformin.； People who are prone to bloating and diarrhea will have severe gastrointestinal reactions after taking acarbose that will make them unable to endure it. Not to mention that the current price of GLP-1 is not affordable. If you only have slightly high blood sugar and no other risk factors, you cannot afford to spend the money and bear the side effects. I met an aunt in her 50s before. She heard from neighbors in the community that acarbose could prevent diabetes, so she secretly went to the drugstore to buy it. After a week of not taking it, she had diarrhea every day and became dehydrated. Finally, she came to the emergency room for rehydration, but she was in trouble.

Early studies also mentioned that thiazolidinedione drugs such as pioglitazone can also reduce the risk of diabetes. However, because long-term use may increase the risk of edema, fractures and even cardiovascular disease, it is currently not recommended as a priority in clinical practice for diabetes prevention. Oh, yes, I also want to mention that the above mentioned type 2 diabetes accounts for more than 90% of the total number of people with diabetes. Type 1 diabetes is caused by autoimmune destruction of pancreatic islet cells. Currently, there is no drug that can effectively prevent it in the world.

In fact, to use an analogy, diabetes prevention is like applying the brakes to a car that is about to go downhill. Lifestyle adjustments are the safest foot brakes. It costs nothing and has no side effects. You just have to keep applying the brakes without letting up. Medicine is like an auxiliary handbrake. You can only apply the brakes when you can't apply the foot brakes and you really can't control it. You can never use the handbrake as the main brake. If you really want to prevent diabetes, you should first replace the milk tea in your hand with warm water, and take one less stop to walk home from work. If you insist on it for two months, your blood sugar may be normal. If you can't get enough, you will think about taking medicine. If you really need medicine, you must let a doctor evaluate your physical condition before choosing. Buying and eating randomly will only make you suffer.