An editorial in JAMA recently debates the prevention of progression of prediabetes to diabetes (Echouffo-Tcheugui, 2023)
Prediabetes, an intermediate stage between normal glucose regulation and diabetes, affects 1 in 3 adults in the USA. And approximately 10% of people with prediabetes progress to having diabetes each year.
A meta-analysis found that prediabetes at baseline was associated with increased mortality and increased cardiovascular event rates (excess absolute risk, 7.4 per 10 000 person-years for mortality; and 8.8 per 10 000 person-years for cardiovascular disease during 6.6 years).
Intensive lifestyle modification, consisting of calorie restriction, increased physical activity (≥150 min/wk), self-monitoring, and motivational support, decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period.
And metformin decreased the risk of diabetes among individuals with prediabetes by an additional 3.2 cases per 100 person-years during 3 years.
The authors conclude:
First-line therapy for prediabetes is lifestyle modification that includes weight loss and exercise or metformin. Lifestyle modification is associated with a larger benefit than metformin.”
