Q: I read your article from several months ago about prediabetes and discussed my risk factors with my doctor (obese, relatively inactive, two siblings with diabetes, and I had gestational diabetes with my last pregnancy six years ago).
She advised that I undertake the exercise regimen you mentioned: brisk walking for 30 minutes five days a week, and cut down my calorie intake. I’ve been following this recommendation, but the weight just doesn’t seem to be coming off. Is there anything else I can do?
A: An interesting study was published about five years ago, in the well-respected British medical journal Lancet, in which 157 individuals at high risk of developing diabetes were given lifestyle instructions alone (which you’ve been doing), a twodrug regimen of metformin and pioglitazone, or a three-drug regimen containing the same two drugs plus another medication called GLP-1RA.
Over the following 32 months, the portion of each group that developed diabetes was 4.1% in the lifestyle-only group, 1.7% in the two-drug group, and 0% in the three-drug group.
It was also noted that the two-drug regimen costs about $10 per month and the three-drug regimen costs between $500 $600 per month.
Unfortunately, since then, further study has shown that pioglitazone use for more than one year has been associated with a slightly increased risk of bladder cancer. Another drug in the same class, sitagliptin, has been shown to have the same beneficial effect on diabetes, with an even greater improvement in fats in the bloodstream (lipids) and greater weight loss.
Given these results, I would certainly recommend you speak with your physician about possibly starting metformin and sitagliptin, in addition, of course, to continuing your exercise program.
I want to thank Jayne C. for this question. If you have any particular topic you would like to hear more about, please message me at paulmdake@gmail.com.
To learn more about this and many other health topics, visit the American Academy of Family Physicians’ website familydoctor. org, where you can search for your topic of interest.
Dr. Paul Dake, a Newberry native, is a retired family physician. He lives in Pinconning, Michigan.
