Metformin Use in Patients with Prediabetes.

[Argirios Argiriou]

May 19, 2015

Jamaluddin Moloo, MD, MPH reviewing Moin T et al. Ann Intern Med 2015 Apr 21.

Although metformin can help prevent progression to type 2 diabetes in prediabetic adults, it was prescribed for fewer than 4%.

In 2002, the Diabetes Prevention Program Research Group reported that, in overweight adults with impaired glucose metabolism, lifestyle intervention and metformin lowered the incidence of type 2 diabetes by 58% and 31%, respectively, relative to placebo, during 3 years of follow-up (NEJM JW Gen Med Mar 15 2002 and N Engl J Med 2002; 346:393). Although lifestyle interventions have received considerable attention, little is known about metformin use to prevent diabetes. In this retrospective cohort study, researchers examined health insurance claims data to assess metformin use among >17,000 adults (age range, 19–58) with prediabetes between 2010 and 2012.

During the study, only 3.7% of patients received prescriptions for metformin. Among those with body-mass indexes >35 kg/m2 or gestational diabetes, the prevalence of metformin prescription was 7.8%.

COMMENT

Metformin prevents or delays progression to diabetes in some prediabetic patients. The authors believe that their findings indicate substantial underuse of metformin. However, we don't know whether giving metformin to this population eventually will pay off in clinically meaningful reductions in microvascular or macrovascular complications. Moreover, a recent re-analysis of Diabetes Prevention Program data suggested that metformin delayed progression to formal diagnoses of diabetes in a relatively small subgroup of prediabetic patients who were at highest baseline risk for progression (NEJM JW Gen Med May 1 2015 and BMJ 2015; 350:h454).

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Jamaluddin Moloo, MD, MPH at time of publication
Grant / Research supportColorado Health Foundation

CITATION(S):

Moin T et al. Metformin prescription for insured adults with prediabetes from 2010 to 2012: A retrospective cohort study. Ann Intern Med 2015 Apr 21; 162:542. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)
PubMed abstract (Free)

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[Argirios Argiriou]

Miriam E. Tucker
April 02, 2019

Safe and Cheap Metformin Prevents Type 2 Diabetes Over 15 Years.


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[Argirios Argiriou]

Diabetes Care 2020 Sep; 43(9): 1988-1990.

Metformin Should Be Used to Treat Prediabetes in Selected Individuals

In conclusion, we believe that metformin should be used to treat prediabetes selectively. The efficacy, safety, and cost-effectiveness of metformin therapy were demonstrated among very high-risk individuals. Assurance of achieving the same beneficial effects is most secure when metformin therapy is prescribed to individuals who meet eligibility criteria for the DPP. Recognizing the heterogeneity of treatment effect, metformin therapy should also be limited to individuals who are at highest risk and most likely to benefit, including those who are younger, more obese, more hyperglycemic, or who have histories of gestational diabetes mellitus. We reject Dr. Davidson’s argument that there is no benefit to the early aggressive treatment of prediabetes in people at very high risk for developing diabetes if the underlying pathophysiologic process is not altered. Early use of metformin can delay the emergence of overt but often unrecognized hyperglycemia that causes microvascular and neuropathic complications and is associated with increased cardiovascular risk. By delaying or preventing the onset of diabetes, metformin therapy is likely to have direct benefits on long-term complications and health-related quality of life.

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