[caption id="attachment_13049" align="aligncenter" width="304"] Average A1C and blood glucose values in the pre-diabetic range[/caption]

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. After these lifestyle changes, 58% of the study participants prevented (or significantly delayed) the development of type 2 diabetes. As a result of that study, Centers for Medicare and Medicaid Services recently announced that they will provide funding programs that help people achieve these kinds of lifestyle modifications. However, as we all know, it's not easy make these permanent lifestyle changes -- we are all creatures of habit. Take a look at some of the contestants on “The Biggest Loser” -- they lost 50, 100, even 150 pounds! But after 6 years, most of them have gained most of it back. So, losing weight through diet and exercise is not the complete answer. It works for some people, but not for others.

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"] Results of DPP Study (2002)[/caption]

So, why aren't we using Metformin to prevent diabetes?

Many medical experts have recommended that metformin, as well as other diabetes drugs, be approved for people with prediabetes. Metformin has several advantages over the other drugs: it's very safe and inexpensive, with the ‘co-pays’ at around $4 per month. It's also associated with lower mortality, lower rates of heart disease, and lower rates of cancer. Metformin has even been shown to increase the lifespan of animals, and the FDA has now given the go ahead for a trial to see if it has the same effect on humans. However, despite experts' recommendations, the FDA has not approved any medication for the treatment of prediabetes.

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. 
• Stevens JW, Khunti K, Harvey R, Johnson M, Preston L, Woods HB, Davies M, Goyder E. Preventing the progression to type 2 diabetes mellitus in adults at high risk: a systematic review and network meta-analysis of lifestyle, pharmacological and surgical interventions. Diabetes Res Clin Pract. 2015 Mar;107(3):320-31. doi: 10.1016/j.diabres.2015.01.027. Epub 2015 Jan 21. PubMed PMID: 25638454.
• Claesen M, Gillard P, De Smet F, Callens M, De Moor B, Mathieu C. Mortality in Individuals Treated With Glucose-Lowering Agents: A Large, Controlled Cohort Study. J Clin Endocrinol Metab. 2016 Feb;101(2):461-9. doi: 10.1210/jc.2015-3184. Epub 2015 Dec 17
• Morales DR1, Morris AD. Metformin in cancer treatment and prevention. Annu Rev Med. 2015;66:17-29. doi: 10.1146/annurev-med-062613-093128. Epub 2014 Nov 6 (metformin and cancer)
• Zimlich R. Could metformin be the fountain of youth?