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

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 rosiglitazone Medication), showed that there was no significant difference in overall cardiovascular outcome between the treatment and placebo groups, although 14 patients in the rosiglitazone 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 unknown, 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.