Diabetes Prevention in the Primary Care Setting

Background: The purpose of this article is to review the treatment of prediabetes with intensive lifestyle intervention alone or in combination with metformin and to examine which patients would benefit the most from the treatment of prediabetes with metformin. Methods: Meta-analysis, randomized-controlled trials, and systematic reviews were searched using the PubMed®, MEDLINE®, and Google Scholar® databases. From the home page of PubMed®, using the advanced search link, “metformin for prediabetes”, “diabetes prevention” was typed into the search builder. Similarly, a MEDLINE® and Google Scholar® search was performed using the advanced search link “metformin for prediabetes”. Eighteen pertinent articles were retrieved and served as the basis for this clinical practice review. Results: Metformin is a safe, cost-effective treatment option for diabetes prevention in high-risk patients when used alone or in combination with intensive lifestyle intervention. Conclusions: Potentially irreversible pathophysiologic changes occur during the prediabetes phase. The American Diabetes Association recommends early intensive lifestyle intervention to circumvent the progression to a type 2 diabetes status. The American Diabetes Association suggests pharmacological therapy, with metformin, for prediabetic patients that are at “high-risk” for type 2 diabetes by having one or more of the following: BMI of 35 or greater, age under 60 years, past medical history of gestational diabetes, increasing A1C levels despite lifestyle intervention, or A1c greater than 6.0%. The Diabetes Prevention Program defines “high-risk” prediabetes patients as having fasting plasma glucose 95-119 mg/dL, BMI≥22 kg/ for Asian Americans, and BMI≥24 kg/ for all other races. The Diabetes Prevention Program showed that after 2.8 years, the incidence of type 2 diabetes was reduced by 31% in prediabetics taking metformin compared to a relative risk reduction of 39% with intensive lifestyle intervention