Oral anti-diabetic drugs for the prevention of Type 2 diabetes

Diabet Med. 2011 Aug;28(8):948-64. doi: 10.1111/j.1464-5491.2011.03303.x.


Aim: To determine the comparative efficacy of oral anti-diabetic drugs in preventing the development of Type 2 diabetes.

Methods: A systematic literature search of MEDLINE, EMBASE and Cochrane CENTRAL was conducted for randomized controlled trials evaluating oral anti-diabetic drugs in patients at high risk for developing Type 2 diabetes. Mixed-treatment comparison meta-analysis methods were used to evaluate the relative risks and risk differences of developing Type 2 diabetes, along with associated 95% credible intervals.

Results: Overall, 20 trials (n = 23 230 participants) were included. Upon mixed-treatment comparison meta-analysis, thiazolidinediones, alpha-glucosidase inhibitors and biguanides significantly reduced the relative risk of developing diabetes by 64, 40 and 27%, respectively, compared with control. Sulphonylureas and glinides showed no significant effect. Moreover, thiazolidinediones significantly reduced the relative risk of diabetes by 50% compared with biguanides and trended towards a 40% risk reduction vs. alpha-glucosidase inhibitors [relative risk 0.60 (95% credible intervals 0.34-1.02)]. None of the results were appreciably altered upon subgroup or sensitivity analyses. When evaluating risk differences compared with control, thiazolidinediones (-9%, number needed to treat = 11), alpha-glucosidase inhibitors (-7%, number needed to treat = 14) and biguanides (-7%, number needed to treat = 14) continued to show significant benefit.

Conclusions: Of the oral anti-diabetic drugs evaluated to prevent Type 2 diabetes, thiazolidinediones were associated with the greatest risk reduction compared with control and associated with greater risk reduction than biguanides. Alpha-glucosidase inhibitors and biguanides performed similarly, and better than control, while sulphonylureas and glinides provided no significant benefit.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Administration, Oral
  • Biguanides / therapeutic use*
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Female
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Thiazolidinediones / therapeutic use*
  • alpha-Glucosidases / therapeutic use*


  • Biguanides
  • Hypoglycemic Agents
  • Thiazolidinediones
  • alpha-Glucosidases