DREAM研究:罗格列酮而非雷米普利阻断向糖尿病的进展

DREAM: rosiglitazone, but not ramipril, to prevent progression to diabetes

罗格列酮8mg/d可显著降低空腹血糖受损或糖耐量减低患者进展为2型糖尿病或发生死亡的风险。7例这样的患者接受罗格列酮治疗3年可有1例不发生糖尿病或死亡。根据雷米普利和罗格列酮降低糖尿病发生率评价(DREAM)试验,虽然罗格列酮组中有14例而安慰剂组仅2例发生心力衰竭,但受试组与对照组的总体心血管终点事件无显著差异。虽然该试验中罗格列酮的终点事件相对风险降低,但其长期的益处与安全性还不清楚。目前该药仅被批准用于2型糖尿病的治疗且较昂贵。因此,对糖尿病高危患者的预防仍然首选改变生活方式。

Rosiglitazone 8 mg daily significantly reduces the risk of progression to type 2 diabetes or death in patients with impaired fasting glucose or impaired glucose tolerance. Seven such patients are treated with rosiglitazone for three years, and one person doesn＇t develop diabetes or death. The trial, DREAM（Diabetes Reduction Assessment with ramipril and msiglitazone Medication）, showed that there was no significant difference in overall cardiovascular outcome between the treatment and placebo groups, although 14 patients in the msiglitazone group developed heart failure compared with only two patients given placebo. Although the relative risk reduction with rosiglitazone treatment in the trial was impressive, the long-term benefits and safety of rosiglitazone are still tinknown, the drug is currently only licensed for the treatment of type 2 diabetes and therapy is expensive. Therefore lifestyle modifications should be encouraged first-line in people at risk of progression to diabetes.