Can High-Fiber Cereal Slow Liver Fibrosis in T2DM Patients?
A three-arm RCT shows 24 g/day dietary fibre improves HbA1c and the FIB-4 fibrosis marker in type 2 diabetes with MASLD. PICO summary and expert commentary for clinicians.
Hormone Insight Editorial Team
Clinical archive
CARDS: Atorvastatin Reduces Cardiovascular Events by 37% and Stroke by 48% in Type 2 Diabetes Regardless of LDL Level
CARDS demonstrated that atorvastatin 10 mg reduces major cardiovascular events by 37% and stroke by 48% in patients with type 2 diabetes and normal to mildly elevated LDL-cholesterol without prior CVD, confirming that cardiovascular risk rather than LDL level should determine statin initiation and establishing universal statin use in primary cardiovascular prevention for type 2 diabetes.
Heart Protection Study: Simvastatin Reduces Vascular Events by 24% in All High-Risk Patients Regardless of Baseline LDL
HPS demonstrated that simvastatin reduces major vascular events by 24% across all high-risk patients regardless of baseline LDL-cholesterol level, including those with diabetes without established coronary disease, eliminating the treatment threshold concept and establishing absolute cardiovascular risk as the primary criterion for statin therapy — one of the most influential results in preventive cardiology.
WOSCOPS: Pravastatin Reduces Coronary Events by 31% in Primary Prevention — Establishing Statins Beyond Secondary Care
WOSCOPS demonstrated that pravastatin reduces the combined incidence of nonfatal MI and coronary death by 31% in men with hypercholesterolaemia and no prior MI, establishing the primary prevention indication for statin therapy and providing the first large randomised evidence for population-level lipid lowering in high-risk individuals without established cardiovascular disease.
4S: Simvastatin Reduces Mortality by 30% and Coronary Death by 42% in Established Coronary Heart Disease
The 4S trial demonstrated that simvastatin reduces all-cause mortality by 30%, coronary death by 42%, and major coronary events by 34% in patients with established coronary heart disease and no excess non-cardiovascular mortality, resolving the safety debate and establishing statin therapy as the standard of care in secondary cardiovascular prevention.
DPPOS: 10-Year Follow-Up Confirms Durable 34% Reduction in Diabetes Incidence From Lifestyle Intervention
The DPPOS demonstrated that cumulative diabetes prevention from the DPP lifestyle intervention and metformin persists over 10 years from original randomisation, with 34% and 18% reductions in cumulative diabetes incidence despite post-DPP convergence of care, establishing a diabetes prevention legacy effect and confirming the durability of early preventive intervention.
DREAM: Rosiglitazone Reduces Diabetes Incidence by 60% in Pre-Diabetes — A Landmark Trial Overtaken by Safety
The DREAM trial demonstrated that rosiglitazone reduces incident diabetes or death by 60% and achieves normoglycaemia in 50% of high-risk adults with impaired glucose tolerance, the largest pharmacological diabetes prevention effect documented in a large RCT, but the drug's subsequent cardiovascular safety concerns and market withdrawal have prevented translation of these findings into clinical practice.
Diabetes Prevention Program: Lifestyle Intervention Reduces Type 2 Diabetes Incidence by 58% in High-Risk Adults
The Diabetes Prevention Program demonstrated that intensive lifestyle intervention reduces type 2 diabetes incidence by 58% with a NNT of 6.9 over 2.8 years in high-risk adults, outperforming metformin which reduced incidence by 31%, establishing structured lifestyle modification as the primary preventive strategy for pre-diabetes and the evidence base for national prevention programmes.
VADT: Intensive Glucose Control Provides No Cardiovascular Benefit in Long-Standing High-Risk Type 2 Diabetes
VADT demonstrated that intensive glucose control achieving a median HbA1c of 6.9% did not significantly reduce cardiovascular events or mortality in veterans with long-standing type 2 diabetes and high cardiovascular disease prevalence, completing the ACCORD/ADVANCE/VADT triptych that defined the limits of aggressive glycaemic management in advanced disease.
ADVANCE: Intensive Glucose Control Reduces Nephropathy by 21% in High-Risk Type 2 Diabetes Without Mortality Harm
ADVANCE demonstrated that intensive glucose control targeting HbA1c below 6.5% using a gliclazide-based strategy reduces nephropathy by 21% and the microvascular composite by 14% in high-risk type 2 diabetes, without the mortality hazard observed in ACCORD, providing important context for how glycaemic targets and treatment strategies interact with safety outcomes.