A1C Chart: Average A1C and blood glucose values in the pre-diabetic range
What is Prediabetes?
Prediabetes describes a condition in which blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. If you have prediabetes, you are at a high risk of developing type 2 diabetes within 10 years unless you take preventative measures.
How can you prevent Prediabetes from becoming diabetes?
Lifestyle Changes
In 2002, the Diabetes Prevention Project (DPP) studied people with prediabetes who underwent intensive lifestyle intervention: 30 minutes of exercise per day, dietary changes, and at least 7% weight loss.

Metformin
With all of the focus on lifestyle intervention, many people have lost sight of the fact that the DPP study included another approach – using metformin, a type 2 diabetes medication. People treated with metformin were 31% less likely to have their prediabetes develop into diabetes. It was not quite as effective as lifestyle modification, BUT a 31% reduction in the rate of progression to diabetes is still significant. Since lifestyle modifications and metformin are both somewhat effective in preventing diabetes, but neither is 100% effective, it seems logical to combine them. [caption id="attachment_13067" align="aligncenter" width="650"]
So, why aren't we using Metformin to prevent diabetes?

OK... what about using it off-label?
Whenever doctors prescribe metformin to people who don't have diabetes, they're often told that the medication will not be approved by a pharmacy or insurance company. Doctors need to fight for an exception to the “diabetes only” rule.What's the upshot?
Prediabetes is common condition -- 86 million cases in the US, and 192 cases worldwide -- and if not treated, many millions of people will develop type 2 diabetes. There are already nearly 500 million people with diabetes worldwide -- we need to curb this epidemic. Lifestyle changes are one solution, but they are not the only solution, and they do not work for everyone. Metformin is safe, effective and even has benefits that extend far beyond preventing diabetes. Why not use it? In light of the circumstances we face, we can't afford to let any resources go unused. The FDA needs to approve medications for treatment of people with prediabetes, especially metformin, as soon as possible. NOTE: Metformin should not be taken by people with kidney disease. It should be discontinued when someone becomes dehydrated, when they have surgery, or if they get certain types of X-rays with a contrast agent. There is a very small chance – about 1 in 30,000 – that metformin can cause a serious condition called lactic acidosis. References:- American Diabetes Association.
- Centers for Disease Control and Prevention (CDC) Diabetes Home.
- International Diabetes Federation (IDF). Diabetes Atlas 2015.
- The Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med.2002;346:393–403. [PMC free article]
- The Preventing Diabetes in Medicare Act. (HR1686).
- After “The Biggest Loser”, their bodies fought to regain weight.
- Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, Dagogo-Jack S, DeFronzo RA, Einhorn D, Fonseca VA, Garber JR, Garvey WT, Grunberger G, Handelsman Y, Henry RR, Hirsch IB, Jellinger PS, McGill JB, Mechanick JI, Rosenblit PD, Umpierrez GE. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2016 executive summary. Endocr Pract. 2016 Jan;22(1):84-113. doi: 10.4158/EP151126.CS. PMID: 26731084
- American Diabetes Association. Standards of Medical Care in Diabetes - 2016. Diabetes Care, January 2016 Volume 39, Supplement 1.
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- Zimlich R. Could metformin be the fountain of youth?