One of the most common diseases treated in our obese/overweight populations is Diabetes. Why are we hesitant to using Metformin early? Early use of Metformin has been a topic for years with the US Diabetes Prevention Program (DPP) results and the follow-up DPP Outcomes Study (DPPOS). Both of these studies have shown the decrease in the prevalence of diabetes developing with the addition of metformin. Combined with lifestyle modifications, results were even better.
Metformin is one of the oldest anti-diabetics and safe to use. Using Metformin in Prediabetes is off-label, and its use is becoming more mainstream. The studies not only showed the delay in diabetes but also induced weight loss in these patients. The likely mechanism is the reduction in insulin resistance. We’ve seen modest weight reduction when adding to a comprehensive weight loss program. Patients will often state that they now have a decrease in carbohydrate cravings. They also report that they do not feel the “high and crash” if they do have a substantial carbohydrate load.
In my opinion, we should be more aggressive with our Prediabetics. Why wait to treat especially if they have other comorbidities? Prevention of the microvascular and macrovascular effects of Diabetes should be at the forefront of the conversations we have with our patients and our treatment options.
Metformin Underused in Patients With Prediabetes. Medscape. May 01,2015
Ann Intern Med. 2015 Apr 21;162(8):542-8. doi: 10.7326/M14-1773.
Metformin prescription for insured adults with prediabetes from 2010 to 2012: a retrospective cohort study.