The STOP-NIDDM Study is the first international study in IGT-subjects investigating the primary prevention of diabetes by pharmacological intervention.

Type 2 diabetes mellitus is a major health problem associated with excess morbidity and mortality and results in substantial health-care costs. Prevalence of this disorder worldwide will double over the next 25 years. People who develop type 2 diabetes pass through a phase of impaired glucose tolerance. Defects in the action or secretion of insulin are the two major abnormalities leading to development of glucose intolerance.

Resistance to insulin progressively increases when passing from normal glucose tolerance through impaired glucose tolerance to diabetes, whereas secretion of insulin gradually decreases. Glucose tolerance is assumed to remain normal as long as the β cells can compensate for insulin resistance. Impaired glucose tolerance will develop only when insulin secretion fails to compensate fully for such resistance, resulting in postprandial hyperglycaemia. Such a mechanism could be sufficient to induce toxic effects of glucose, which further inhibit secretion and action of insulin and contribute to progression of impaired glucose tolerance to diabetes.

Thus, any intervention in the impaired glucose tolerance phase that reduces resistance to insulin, or protects the β cells, or both, should prevent or delay progression to diabetes. The α-glucosidase inhibitor acarbose improves sensitivity to insulin and decreases postprandial hyperglycaemia, thereby releasing the stress on the β cells. On the basis of these observations, the investigators aimed to assess the effect of acarbose on conversion of impaired glucose tolerance to type 2 diabetes in the Study TO Prevent Non-insulin-dependent diabetes mellitus (STOPNIDDM) trial.

Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Chiasson et al., Lancet, Vol. 359 (2002)

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