DREAM — a diabetes prevention study

he Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM) study reported in September 2006. This international, multicentre, randomised, double blind, placebo controlled, 2-by-2 factorial prospective three-year study examined the effect of rosiglitazone (8 mg/day) and/or ramipril (15 mg/day) to prevent progression to type 2 diabetes in 5,269 adults with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or both. The primary end point (incidence of diabetes or death) was reduced by 60% on rosiglitazone (11.6% on rosiglitazone vs. 26.0% on placebo, p<0.0001), and more subjects regained normoglycaemia on rosiglitazone (50.5%) than placebo (30.3%, p<0.0001). Ramipril did not alter the incidence of diabetes or death (18.1% on ramipril vs. 19.5% on placebo) but more subjects regained normoglycaemia on ramipril (42.5%) than placebo (38.2%, p=0.001). There were no apparent interactions between ramipril and rosiglitazone. Although overall cardiovascular event rates were not significantly different between rosiglitazone and placebo there was an increase in heart failure (0.5% on rosiglitazone vs. 0.1% on placebo, p<0.01) and more oedema on rosiglitazone (6.8%) than placebo (4.9%, p<0.003).