American Journal of Lifestyle Medicine

Abstract: In the United States, over 20 million Americans have diabetes and over a third of them are undiag-nosed. Less than 50 % of the adults in the United States engage in physical activity at the level currently recom-mended for health promotion. Over 70 % of these diabetics will die of car-diovascular disease, the number one killer of all Americans. Physicians should identify and target the ones who are undiagnosed and at high risk (estimated to be over 40 mil-lion) and offer them comprehensive education and lifestyle interven-tions to prevent the development of this deadly and quality of life deplet-ing illness in the prediabetics and better manage the ones who already have the disease. Such an approach will likely impact positively on lower-ing the mortality rate from diabetes and heart disease. There’s a contin-uum of care and with the natural history of the declining function of the beta cell, we may in fact need to use medications to slow progression and treat diabetes. We should how-ever use them thoughtfully and wisely as the stakes and risks are potentially high. Because of the safety of efficacy of Metformin, it should be our medi-cation of first choice for nearly all our patients with impaired glucose tolerance and those with type 2 diabetes