Commentary on STOP DIABETES study

In this real-world observational, retrospective study, it was evaluated whether it was possible to stop the conversion of prediabetes to diabetes (Type 2) through lifestyle or pharmacological therapy. It was based on personalized interventions, and pathophysiology, beta-cell function, and glucose tolerance, were assessed. If the intervention improved beta-cell function, it was a strong predictor that prevention of progression from prediabetes to diabetes would happen. There are limitations of the study, but it showed that even people with normal glucose tolerance do progress to diabetes and should be a subgroup that needs intervention as they too are prediabetic, rather than assume that such patients will not progress, and only those with impaired glucose tolerance would progress. Compared with participants, who received lifestyle therapy only, progression to type 2 diabetes was significantly lesser in participants who received triple, rather than in those receiving dual, oral antidiabetic therapy. Improved beta-cell function was the strongest predictor of type 2 diabetes prevention. Whether these data are applicable to other populations is debatable. It is also debatable whether the results reflect the prevention or masking of diabetes through pharmacological treatment. Determining the contribution of each agent alone to the reduction in diabetes incidence is not possible. Finally, the lifestyle intervention was not as rigorous as practiced in the Diabetes Prevention Project