Should the 79 million Americans with prediabetes be on metformin to prevent Diabetes? In a study published in Diabetes Care (Diabetes Care. 2012;35:663-665, 731-737) the authors support a previous study which showed a 31% reduction in the incidence of diabetes in patients at risk for developing diabetes when given metformin. They reported minimal side affects. They also noted a 2% weight loss which was maintained over a 10 year period. Compared to people who lost similar amounts of weight with caloric reduction, patients who took metformin released more adipose tissue, and kept more lean muscle mass. The authors also noted that cellular metabolism changed in a manner similar to people who exercised. They supported a previous study which claimed metformin is a cost effective alternative to life style changes. While the 31% reduction in the incidence is a tremendous benefit to people at risk for developing diabetes, I feel the 59% reduction in the incidence of developing frank diabetes with diet and exercise alone is even greater benefit. Rather than choosing between the two modalities, it makes sense to start with diet and exercise and consider the benefit of adding metformin. Let us know how you feel about this.
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