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A pill taken once a day in the morning prevented type 2diabetes in more than 70 percent of individuals whose obesity, ethnicity and other markers put them at highest risk for the disease, U.S. scientists have reported. 

The team also noted a 31 percent decrease in the rate of thickening of the carotid artery, the major vessel that supplies blood to the brain. The study, which enrolled 602 participants through The University of Texas Health Science Center San Antonio and seven collaborating centers, is described in the New England Journal of Medicine and has direct implications for the care of 40 million Americans who are pre-diabetic. 

"It's a blockbuster study," said senior author Ralph DeFronzo, M.D., professor in the School of Medicine and chief of the diabetes division at the UT Health Science Center San Antonio. "The 72 percent reduction is the largest decrease in the conversion rate of pre-diabetes to diabetes that has ever been demonstrated by any intervention, be it diet, exercise or medication." 

Dr. DeFronzo led the trial of pioglitazone, which is marketed as Actos® by Takeda Pharmaceutical Co. Ltd. The Japanese company provided an independent investigator grant to Dr. DeFronzo to conduct the ACT Now study. Some patients were followed for as long as four years; the average follow-up was 2.4 years. 

Pioglitazone is widely used as an insulin sensitizer in patients with type 2 diabetes. In the ACT Now study, participants were chosen because of their high risk for diabetes, including obesity, family history and impaired glucose tolerance as demonstrated by a glucose test. 

"The drug shows outstanding results," said Robert R. Henry, M.D., president, medicine and science, of the American Diabetes Association. "It is the most efficacious method we have studied to date to delay or prevent the onset of type 2 diabetes." A study co-investigator, Dr. Henry is professor of medicine at the University of California, San Diego, and chief of the section of endocrinology and diabetes at the VA San Diego Healthcare System. 

Robert Chilton, D.O., FACC, a UT Health Science Center San Antonio cardiologist who was not involved with the study, said the slowing of carotid artery thickness indicated that the participants' glucose was well controlled, preventing blood vessel damage that leads to heart attacks, strokes and peripheral vascular disease.