Diabetes prevention drugs

Currently, there are only three types of drugs that are clinically recognized as having clear diabetes prevention effects - metformin, α-glucosidase inhibitors (such as acarbose), and GLP-1 receptor agonists (semaglutide, liraglutide, etc. all fall into this category). However, they are by no means a "anti-diabetic miracle drug" suitable for all high-risk groups, nor are they a universal choice for healthy people to offset the harm of eating and drinking, and to prevent diabetes while lying down. This is not said casually. It was clearly marked in last year's American Diabetes Association (ADA) guidelines and my country's "China Type 2 Diabetes Prevention and Treatment Guidelines". However, in actual clinical scenarios, the differences in medication choices between different doctors are actually quite large.

Last week, I met a 32-year-old Internet operator in the endocrinology clinic. He had a BMI of 28 and was diagnosed with abnormal glucose tolerance. I saw a blogger who said that semaglutide "can help lose weight and prevent diabetes." The old director who received the diagnosis was so angry that he knocked on the table after reading the checklist: "What are you making fun of? In your case, if you adjust your diet and exercise for three months, you will most likely be able to bring your blood sugar back. Is it necessary to do this?" However, the young doctor in the same department also talked to me privately, saying that if this happened For young people whose BMI exceeds 32, both parents are diabetic, have developed obvious insulin resistance, and cannot spare time to exercise every day, early intervention with medication is a more cost-effective option. If they develop lifelong diabetes, it will be more troublesome.

Both statements actually have basis. Now the academic circle is divided into two groups: conservatives insist that "lifestyle intervention is the first priority for prevention". After all, 3 to 6 months of dietary adjustment + regular exercise can bring more than 50% of people with abnormal glucose tolerance back to normal blood sugar levels without drug side effects; radicals believe that the compliance of high-risk groups is too low. It is good if 2 out of 10 people can persist in exercising. Early intervention with drugs with clear safety can reduce the risk of subsequent complications.

Talking back to the specific medicines, the one I encountered the most during free clinics in the community was metformin to prevent diabetes. It is cheap, only a dozen yuan per box, and the side effects are mild. Most of them cause bloating and diarrhea at the beginning, but they get used to it after a week or two. It is especially suitable for people in their forties or fifties with abdominal obesity. For people who are obese, whose fasting blood sugar is 0.5~1mmol/L higher than the normal value, and who usually can't keep their mouth shut and are too lazy to move. An old doctor I know in the community has prescribed it for more than ten years. Many people have been taking it for five or six years, and their blood sugar has been very stable. The only thing to note is that people with poor kidney function cannot use it. Acarbose is even more interesting. It is suitable for people who cannot live without rice and noodles and whose blood sugar levels are extremely high after meals. My uncle Zhang downstairs eats two large bowls of hand-made noodles every day. After being diagnosed with abnormal glucose tolerance, he took acarbose for more than half a year. Now his blood sugar after meals is basically within the normal range. The only worry is that he farted a lot when he first started taking the medicine. He said that in the first two months, he did not dare to sit in a full elevator for fear of picking his feet due to embarrassment.

The most controversial thing is definitely GLP-1 drugs. Nowadays, there are many people on the Internet who are bragging about it and many people are criticizing it. Experts who support it believe that it can not only lower blood sugar, but also lose weight and protect cardiovascular systems. It is used for people at high risk of diabetes who also have high blood lipids and high blood pressure. The benefits far outweigh the risks. Experts who oppose it believe that it is too severely abused. Many people with completely normal blood sugar use it blindly to lose weight, but instead suffer from pancreatitis and thyroid C cell hyperplasia. Moreover, this type of drug has not been on the market for too long, and the long-term safety data of 20 to 30 years is not sufficient. There is no need to take this risk for people who can adjust their lifestyle. My own experience is that unless your blood sugar level is still not up to standard after adjusting your lifestyle for more than 3 months, or you already have underlying cardiovascular disease, you will not be prescribed this type of medicine.

By the way, by the way, all the health care products on the market that claim to be "purely natural" and "no side effects" and can prevent diabetes are all IQ taxed. Previously, a health care product manufacturer asked me to cooperate, saying that their Pueraria lobata pills can 100% block diabetes, but I rejected it directly. If it really has this effect, it would have won the Nobel Prize long ago, so there is no need to advertise in the circle of friends.

To be honest, all the drugs to prevent diabetes cannot replace keeping your mouth shut and moving your legs. I once had a patient who took metformin, drank milk tea and fried chicken every day, and drank three meals a week. He was diagnosed with type 2 diabetes in less than half a year. It was useless to come to me crying. Diabetes prevention is inherently a very personalized matter, and there is no unified standard answer. It is best to consult an endocrinologist at a regular hospital for evaluation before making a decision on whether or not to take medicine. Do not follow the trend and buy and eat blindly. After all, medicines are three-part poison. This is true at all times.