Dalcetrapib, a cholesteryl ester transfer protein (CETP) inhibitor, may prevent or delay the onset of diabetes in patients with acute coronary syndrome (ACS), according to study results published in Diabetes Care.

Although there are several potential approaches to prevent incident diabetes, including use of metformin, acarbose, basal insulin, valsartan, orlistat, lorcaserin, lifestyle modification, and bariatric surgery, these treatments have not been adopted widely. Previous studies have suggested that CETP inhibitors may have positive effects on lipid profile and as such, the goal of the current study was to assess the effects of dalcetrapib vs placebo on incident diabetes.

The researchers used data from the dal-OUTCOMES trial (ClinicalTrials.gov Identifier: NCT00658515) that compared treatment with dalcetrapib or placebo in patients with recent ACS. They completed post hoc analyses and included data on 5141 patients with diabetes (2573 treated with dalcetrapib and 2568 treated with placebo) and 10,645 patients without diabetes (5326 treated with dalcetrapib and 5319 treated with placebo).

During a median follow-up of 30 months, diabetes developed in 403 of 5326 patients (7.6%) treated with dalcetrapib and in 516 of 5319 patients (9.7%) in the placebo group (absolute risk reduction, 2.1%). Dalcetrapib prolonged time to onset of diabetes (hazard ratio, 0.77; 95% CI, 0.67-0.89; P <.001), with a need to treat 40 patients for 3 years to prevent 1 incident case. When considering only individuals with prediabetes at baseline, the number needed to treat for 3 years to prevent 1 incident case of diabetes was 25.

Compared with placebo, treatment with dalcetrapib was associated with fewer patients progressing from normoglycemia to prediabetes (38.5% vs 43.1%; odds ratio, 0.83; 95% CI, 0.73-0.94; P =.004) and more patients regressing from a diabetic to a nondiabetic state (13.8% vs 11.3%; odds ratio, 1.25; 95% CI, 1.06-1.49; P =.01).

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The study had several limitations, including its post hoc design and the inherent inaccuracies in determining incident diabetes with criteria other than standard glucose tolerance testing.

Taken together, the researchers concluded that their results indicated that “[d]alcetrapib might have utility as a well-tolerated agent to prevent or delay the onset of diabetes in patients at high risk for that condition.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Schwartz GG, Leiter LA, Ballantyne CM, et al. Dalcetrapib reduces risk of new-onset diabetes in patients with coronary heart disease [published online March 6, 2020]. Diabetes Care. doi: 10.2337/dc19-2204