Oral Antidiabetic Drugs and Regression from Prediabetes to Normoglycemia: A Meta-Analysis

ed hemoglobin A1c (A1C) are intermedi-ate stages between normoglycemia and overt type 2 diabetes mellitus (T2DM). These stages are often referred to as predi-abetes.1,2 Criteria for diagnosis of predia-betes are set by the World Health Organi-zation and the American Diabetes Associ-ation (ADA)2-7 and are based on blood glucose levels after oral glucose tolerance test or after fasting or an A1C test. Defini-tions have changed over the years; for ex-ample, the most recent ADA criteria for prediabetes include elevated A1C of 5.7-6.4%, IGT defined by 2-hour plasma glu-cose level following a 75-g oral glucose tolerance test of 140-199 mg/dL, or IFG defined by fasting plasma glucose level of 100-125 mg/dL.2 These prediabetic states are associated with increased risk of pro-gression to T2DM8 and its associated macro- and microvascular complications.1 Patients with prediabetes are at increased risk of developing cardiovascular disease, independent of diabetes development.8,9 Moreover, studies have also found that cardiovascular mortality and all-cause mortality are higher in people with predia-betes than in those with normoglycemia.1 Active interventions such as lifestyle modification or pharmacologic therapy are attractive options to reduce some of the risks associated with prediabetes. Current guidelines suggest structured lifestyle modification with increased physical activity aimed at losing 5-10 % of body weight as the cornerstone of treatment.2 However, many patients cannot adhere to these measures or need additional assistance to achieve normoglycemia. Data from randomized controlled trial