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Metformin Pre Diabetes Treatment

Metformin For Prediabetes

Metformin For Prediabetes

The oral biguanide metformin (Glucophage, and others) is generally the drug of choice for initial treatment of type 2 diabetes. It has also been used to prevent or at least delay the onset of diabetes in patients considered to be at high risk for the disease. Recent guidelines recommend considering use of metformin in patients with prediabetes (fasting plasma glucose 100-125 mg/dL, 2-hr post-load glucose 140-199 mg/dL, or A1C 5.7-6.4%), especially in those who are <60 years old, have a BMI >35 kg/m2, or have a history of gestational diabetes.1 Metformin has not been approved for such use by the FDA. CLINICAL STUDIES — In the Diabetes Prevention Program (DPP) trial, 3234 nondiabetic adults with a BMI ≥24 kg/m2 (≥22 kg/m2 in Asian patients) and elevated fasting and post-load plasma glucose concentrations were randomized to receive intensive lifestyle intervention focusing on weight loss and exercise, metformin 850 mg twice daily, or placebo.2 After a mean follow-up of 2.8 years, the incidence of diabetes was reduced, compared to placebo, by 58% with intensive lifestyle intervention and by 31% with metformin. Metformin was as effective as lifestyle intervention among patients <60 years old or with a BMI ≥35 kg/m2. When the 3-year DPP trial ended, the intensive lifestyle intervention group was offered semi-annual counseling and the metformin group could continue to take the drug. During a follow-up of 15 years, the average annual incidence of diabetes, compared to placebo, was 27% lower in patients originally randomized to lifestyle intervention and 18% lower in those randomized to metformin.3 ADVERSE EFFECTS — No significant safety issues have been detected with long-term use of metformin. The drug can cause adverse gastrointestinal effects such as metallic taste Continue reading >>

Metformin For Prediabetes

Metformin For Prediabetes

Prediabetes is, for many people, a confusing condition. It’s not quite Type 2 diabetes — but it’s not quite nothing, either. So how concerned should you be about it? For years, the jargon-filled names given to this condition — impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) — may have made the task of taking it seriously more difficult. But in 2002, the American Diabetes Association (ADA), along with the U.S. Department of Health and Human Services, inaugurated the term “prediabetes” to convey the likely result of not making diet or lifestyle changes in response to this diagnosis. In 2003, the threshold for prediabetes was lowered from a fasting glucose level of 110 mg/dl to one of 100 mg/dl. Then, in 2008, the American Diabetes Association (ADA) began recommending the drug metformin for some cases of prediabetes — specifically, for people under age 60 with a very high risk of developing diabetes, for people who are very obese (with a body-mass index, or BMI, of 35 or higher), and for women with a history of gestational diabetes. The ADA also said that health-care professionals could consider metformin for anyone with prediabetes or an HbA1c level (a measure of long-term blood glucose control) between 5.7% and 6.4%. But according to a recent study, metformin is still rarely prescribed for prediabetes. The study, published in April in the journal Annals of Internal Medicine, found that only 3.7% of people with prediabetes were prescribed metformin over a three-year period, based on data from a large national sample of adults ages 19 to 58. According to a Medscape article on the study, 7.8% of people with prediabetes with a BMI of 35 or higher or a history of gestational diabetes were prescribed metformin — still a very low rate for t Continue reading >>

Management Of Prediabetes

Management Of Prediabetes

Treatment Goals The primary goal of prediabetes management is to normalize glucose levels and prevent or delay progression to diabetes and associated microvascular complications (1,2). Management of common prediabetes comorbidities such as obesity, hypertension, dyslipidemia, cardiovascular disease, and chronic kidney disease is also essential. Therapeutic Lifestyle Management Given its safety and the strength of evidence for its effectiveness in improving glycemia and reducing cardiovascular disease (CVD) risk factors, the preferred treatment approach for prediabetes is intensive lifestyle management (1,2). Therapeutic lifestyle management should be discussed with all patients with prediabetes at the time of diagnosis and throughout their lifetimes. Therapeutic lifestyle management includes medical nutrition therapy (MNT; the reduction and modification of caloric and saturated/hydrogenated fat intake to achieve weight loss in individuals who are overweight or obese), appropriately prescribed physical activity, avoidance of tobacco products, adequate quantity and quality of sleep, limited alcohol consumption, and stress reduction (2). While lifestyle modifications may be difficult to maintain, the following strategies have been shown to increase the likelihood of patient success (1,2): Patient self-monitoring Realistic and stepwise goal setting Stimulus control Cognitive strategies Social support Appropriate reinforcement Primary care providers (PCPs) often take on the responsibility of encouraging behavior changes. The Avoiding Diabetes Through Action Plan Targeting (ADAPT) trial has developed a system that combines evidence-based interventions for behavioral change with existing health record technology to improve primary care providers’ ability to effectively couns Continue reading >>

Diagnosis

Diagnosis

Print The American Diabetes Association (ADA) recommends that blood glucose screening for adults begin at age 45, or sooner if you are overweight and have additional risk factors for prediabetes or type 2 diabetes. There are several blood tests for prediabetes. Glycated hemoglobin (A1C) test This test indicates your average blood sugar level for the past two to three months. Specifically, the test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. In general: An A1C level below 5.7 percent is considered normal An A1C level between 5.7 and 6.4 percent is considered prediabetes An A1C level of 6.5 percent or higher on two separate tests indicates type 2 diabetes Certain conditions can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin (hemoglobin variant). Fasting blood sugar test A blood sample is taken after you fast for at least eight hours or overnight. In general: A fasting blood sugar level below 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is considered normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L) is considered prediabetes. This result is sometimes called impaired fasting glucose. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 2 diabetes. Oral glucose tolerance test This test is usually used to diagnose diabetes only during pregnancy. A blood sample is taken after you fast for at least eight hours or overnight. Then you'll drink a sugary solution, and your blood sugar level will be measured again after two hours. In general: A blood sugar level less than 140 mg/dL (7.8 mmo Continue reading >>

Treating Prediabetes With Metformin

Treating Prediabetes With Metformin

Go to: Abstract To determine if the use of metformin in people with prediabetes (impaired glucose tolerance or impaired fasting glucose) would prevent or delay the onset of frank type 2 diabetes mellitus. MEDLINE was searched from January 1966 to the present, and articles meeting the selection criteria were hand searched. Randomized controlled trials that involved administration of metformin to delay or prevent type 2 diabetes in individuals with impaired glucose tolerance or impaired fasting glucose were included. Development of diabetes was a required outcome measure; follow-up time of at least 6 months was required. Three studies met these criteria. The 3 studies varied in ethnicity of the population studied, in the rates of conversion to diabetes from prediabetes, and in the dose of metformin used. In general the studies were well done, although 2 of the 3 did not do true intention-to-treat analyses. A sensitivity analysis was completed by converting all data to intention-to-treat data and assuming a worst-case scenario for the people who were lost to follow-up. Metformin decreases the rate of conversion from prediabetes to diabetes. This was true at higher dosage (850 mg twice daily) and lower dosage (250 mg twice or 3 times daily); in people of varied ethnicity; and even when a sensitivity analysis was applied to the data. The number needed to treat was between 7 and 14 for treatment over a 3-year period. Summary of results from reviewed trials: Development of diabetes outcomes. STUDY OUTCOME EER n/N (%) CER n/N (%) RRR % (95% CI) ARR % (95% CI) NNT N (95% CI) YATES CORRECTED P VALUE COMMENTS Li et al,22 1999 (Primary analysis of 70 participants) Development of diabetes at 12 mo 1/33 (3.0) 6/37 (16.2) 81.3 (−9.5 to 97.0) 13.2 (−0.9 to 17.9) 7.6 (5.5 to infinit Continue reading >>

Experts Recommend Two-pronged Approach To Treating Prediabetes

Experts Recommend Two-pronged Approach To Treating Prediabetes

According to the most recent data compiled by the CDC, 57 million U.S. adults have prediabetes, a figure that has reached pandemic levels. “In an ideal world, you want to diagnose high-risk people early in order to prevent progression to full-blown diabetes and its associated complications,” Glenn Matfin, MD, clinical associate professor at New York University and senior staff physician at the Joslin Diabetes Center, told Endocrine Today. Whether prediabetes progresses to diabetes depends on a number of variable factors, including lifestyle changes, genetics and treatment practices, which have some physicians supporting the use of medication and others vehemently against it. “We draw lines in order to differentiate between normal glucose tolerance, prediabetes and diabetes, but it is an interlinked, continuous chain,” Matfin said. “The clock is ticking, and the health risks rise significantly as prediabetes goes untreated.” To examine the current state of prediabetes treatment, Endocrine Today spoke with a number of experts to best understand how lifestyle and pharmacological approaches should be utilized to reverse glucose functions to normal levels. The issue is also examined from a financial aspect, as the ability to keep patients with prediabetes from turning into patients with diabetes translates into hundreds of millions of dollars saved in health care costs. Ralph DeFronzo, MD, and diabetes experts discuss preferred therapeutic approaches for people with prediabetes. Perhaps due to its subtle set of symptoms, the identification and diagnosis of patients with prediabetes has proved to be a challenge. Research has shown that although 30% of the U.S. population had prediabetes in 2005 to 2006, only 7.3% were aware that they had it. A consensus from diabe Continue reading >>

Metformin For Prediabetes

Metformin For Prediabetes

This Issue The oral biguanide metformin (Glucophage, and others) is generally the drug of choice for initial treatment of type 2 diabetes. It has also been used to prevent or at least delay the onset of diabetes in patients considered to be at high risk for the disease. Recent guidelines recommend considering use of metformin in patients with prediabetes (fasting plasma glucose 100-125 mg/dL, 2-hr post-load glucose 140-199 mg/dL, or A1C 5.7-6.4%), especially in those who are <60 years old, have a BMI >35 kg/m2, or have a history of gestational diabetes.1 Metformin has not been approved for such use by the FDA. Continue reading >>

Approach To The Patient With Prediabetes

Approach To The Patient With Prediabetes

Med Star Clinical Research Center, Washington, D.C. 20003 Search for other works by this author on: Med Star Clinical Research Center, Washington, D.C. 20003 Address all correspondence and requests for reprints to: Robert Ratner, Med Star Clinical Research Center, 650 Pennsylvania Avenue SE, Washington, DC 20003. Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 9, 1 September 2008, Pages 32593265, Vanita R. Aroda, Robert Ratner; Approach to the Patient with Prediabetes, The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 9, 1 September 2008, Pages 32593265, Prediabetes consists of impaired fasting glucose and/or impaired glucose tolerance and is a significant risk factor for the development of type 2 diabetes, microvascular, and macrovascular disease. The values used to define prediabetes are arbitrary, because prediabetes represents an intermediary category along the continuum from normal glucose levels and tolerance to overt hyperglycemia. The progression from prediabetes to type 2 diabetes occurs over many years, strong evidence to support intervention to delay the progression from prediabetes to diabetes. Large, randomized prospective studies with lifestyle intervention and/or various modes of pharmacotherapy have demonstrated successful delay of diabetes. Several issues in the management of prediabetes remain controversial, such as the role of pharmacotherapy and when to escalate treatment. This article will review some of the issues surrounding the identification and treatment of prediabetes, with an interpretation of the available data to help guide management. A 46-yr-old female is referred to you for an abnormal fasting glucose of 115 mg/dl (6.4 mmol/liter). She has no significant p Continue reading >>

What Are Biguanides For Diabetes? Metformin For Diabetes

What Are Biguanides For Diabetes? Metformin For Diabetes

They could come back if your doctor raises your dose. Taking metformin with food can help. While doctors used to avoid prescribing this drug to people who've had kidney trouble, it may be OK for someone with mild or moderate kidney disease . When you use metformin for a long time, it could lower the amount of vitamin B-12 in your body too much. Your doctor may want to check your B-12 level, especially if you have anemia or nerve damage in your feet or hands ( peripheral neuropathy ). One large study has linked long-term metformin use to higher chances of getting Alzheimer's dementia and Parkinson's disease . But we need more research to understand the connection better and what it means. Some people who take metformin can get a lactic acid buildup in their blood. It's rare and more likely to happen if you: Continue reading >>

Metformin Or Lifestyle Modification In The Treatment Of Pre-diabetes

Metformin Or Lifestyle Modification In The Treatment Of Pre-diabetes

Metformin or lifestyle modification in the treatment of pre-diabetes Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program BMJ 2015; 350 doi: (Published 19 February 2015) Cite this as: BMJ 2015;350:h454 Metformin or lifestyle modification in the treatment of pre-diabetes The present article (1) has provided leads to the effectiveness of lifestyle modifications in reducing the incidence of diabetes from a pre-diabetes state in the general population. The common concept of initiating metformin for the treatment of pre-diabetic state, as the only effective measure seems to be limited with the findings of this study. Though metformin treatment reduced the incidence by 21.5% in absolute terms, the benefit was maximal in the quarter with the highest risk of developing diabetes. The effect of lifestyle modification, on the other hand showed six fold reduction in absolute risk (28.3%) in the highest risk quarter, which is higher than metformin group. A meta-analysis study (2) done on three randomized clinical trials showed that metformin decreases the rate of conversion from prediabetes to diabetes. The effective dose was 850 mg twice daily and lower dosage 250 mg twice or 3 times daily was not very effective. The studies were done in people of varied ethnicity. The number needed to treat was between 7 and 14 for treatment over a 3-year period. The study showed variations in the in overall rates of progression to diabetes in these 3 groups. The study from China(3)had an overall rate of conversion to diabetes of 10%; while that from India (4) showed a conversion rate of 48%. In the study(5) with mixed ethnicity (55% white, 20% African American, and only 5% Asian), a rate of conversion to diabetes was 24%. The a Continue reading >>

Prediabetes

Prediabetes

What Is Prediabetes? Prediabetes is a “pre-diagnosis” of diabetes—you can think of it as a warning sign. It’s when your blood glucose level (blood sugar level) is higher than normal, but it’s not high enough to be considered diabetes. Prediabetes is an indication that you could develop type 2 diabetes if you don’t make some lifestyle changes. But here's the good news: . Eating healthy food, losing weight and staying at a healthy weight, and being physically active can help you bring your blood glucose level back into the normal range. Diabetes develops very gradually, so when you’re in the prediabetes stage—when your blood glucose level is higher than it should be—you may not have any symptoms at all. You may, however, notice that: you’re hungrier than normal you’re losing weight, despite eating more you’re thirstier than normal you have to go to the bathroom more frequently you’re more tired than usual All of those are typical symptoms associated with diabetes, so if you’re in the early stages of diabetes, you may notice them. Prediabetes develops when your body begins to have trouble using the hormone insulin. Insulin is necessary to transport glucose—what your body uses for energy—into the cells via the bloodstream. In pre-diabetes, your body either doesn’t make enough insulin or it doesn’t use it well (that’s called insulin resistance). If you don’t have enough insulin or if you’re insulin resistant, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps prediabetes. Researchers aren’t sure what exactly causes the insulin process to go awry in some people. There are several risk factors, though, that make it more likely that you’ll develop pre-diabetes. These are Continue reading >>

Metformin Vs. Lifestyle Changes For Prediabetes

Metformin Vs. Lifestyle Changes For Prediabetes

Metformin vs. Lifestyle Changes for Prediabetes For several years, there has been ongoing research and debate about when its appropriate to take drugs such as metformin to treat prediabetes . Since 2008, the American Diabetes Association has recommended metformin for certain cases of prediabetes, but as we noted in a piece here at Diabetes Flashpoints a couple of years ago, many doctors remain hesitant to follow these recommendations. And earlier this year, we looked at a study that compared the metformin with a lifestyle-based program for Hispanic women with prediabetes and found the lifestyle program to be more beneficial, both for weight loss and for blood glucose control. Now, a recent study appears to confirm that lifestyle programs can be more beneficial than simply taking a pill when you have prediabetes. Published last month in the journal Diabetes Care, the study looked at whether participants with prediabetes went on to develop diabetes, or returned to normal blood glucose levels, within a three-year period. In both cases, the researchers only included participants who adhered to their prescribed regimen, defined as losing at least 5% of their body weight six months into the lifestyle program, or reporting taking at least 80% of their medication six months into taking metformin. As described in a Physicians Briefing article on the study , participants who were deemed to be at lowest risk for developing diabetes at the beginning of the study reduced this risk by 8% by participating in the lifestyle program. Those in the metformin group, however, experienced no reduction in risk compared with a third group that took placebos (inactive pills). Low-diabetes-risk members of the lifestyle group were 35% more likely than those in the placebo group to return to norma Continue reading >>

Prediabetes: Which Treatment Should I Use To Prevent Type 2 Diabetes?

Prediabetes: Which Treatment Should I Use To Prevent Type 2 Diabetes?

Prediabetes: Which Treatment Should I Use to Prevent Type 2 Diabetes? Prediabetes: Which Treatment Should I Use to Prevent Type 2 Diabetes? You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Prediabetes: Which Treatment Should I Use to Prevent Type 2 Diabetes? Make major lifestyle changes to help prevent type 2 diabetes. Take the medicine metformin (Glucophage) to help prevent type 2 diabetes. If you have prediabetes, your blood sugar is higher than it should be. You are more likely to get type 2 diabetes . Major lifestyle changes can help prevent type 2 diabetes in people with prediabetes. These changes include losing weight, eating healthier foods, and getting more exercise. The medicine metformin can also help prevent type 2 diabetes in people with prediabetes. Even if you take metformin, it is important to make as many healthy lifestyle changes as you can. Doing both of these things may give you the best chance of delaying or preventing type 2 diabetes over the long term. Type 2 diabetes can have a big impact on your life. If you get it, you'll probably have to make some changes. For example, you may have to carefully watch what you eat, take medicine every day, and watch for other health problems. Over time, diabetes can harm your eyes, nerves, and kidneys.It can damage your blood vessels. This can lead to heart disease, heart attack, and stroke.You could also have nerve damage. In your feet, this nerve damage can cause slow healing and pain when you walk.Your immune system may become weak and less able to fight infections. The main way to prevent type 2 diabetes is to lower blood sugar Continue reading >>

Metformin For Prediabetes: Success

Metformin For Prediabetes: Success

In a controlled trial, 600 overweight and obese people with prediabetes were given metformin. Metformin is in the biguanide class. It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues. It also can possibly help patients to lose weight, and possibly prevent some forms of cancer. Metformin was discovered in 1922. Study in humans began in the 1950s, by French physician Jean Sterne. It was introduced as a medication in France in 1957 and the United States in 1995. It is on the World Health Organization’s List of Essential Medicines, the most important medications needed in a basic healthcare system. Metformin is believed to be the most widely used medication for diabetes, which is taken by mouth. It is available as a generic medication. The wholesale price in In the United States costs $3 to $25 USD per month. For those patients who are under age 60 with prediabetes, the ADA has recommended metformin for those with a BMI over 34 and for women with gestational diabetes in the past. But, for others, especially for those over the age of 60, and even teenagers who rarely are treated with metformin, the study found that just 3.7% of those with prediabetes were actually prescribed metformin, over a 3-year period. Since metformin has been around since 1950 and even longer overseas and has even been shown to possibly prevent certain kinds of cancer, why should it not be standard procedure to provide all those with prediabetes the option to be treated with metformin? With the cost for the 29 million patients with diabetes at over 300 billion dollars, should we be asking the question: with more than 90 million people in the U.S. with prediabetes — a number that’s still growing — why doesn’t the FDA or the ADA recommen Continue reading >>

Take Metformin If You Have Prediabetes

Take Metformin If You Have Prediabetes

Do you have prediabetes? You might be able to ward it off with the help of one of the diabetes drugs. Metformin might stop you from getting diabetes and could also help you in other ways. But persuading your doctor to prescribe it could be a challenge. The biggest and perhaps the best study of people who have prediabetes showed that taking metformin cuts the risk of diabetes by 31 percent. While this was less than the reduction of 58 percent that the “lifestyle intervention” provided, in real life we usually aren’t able to get that much guidance from our medical team. By “lifestyle intervention” the researchers meant being in a program that provided information, guidance, and support to help participants lose 7 percent or more of their weight and to get moderately intense physical activity — like brisk walking — for at least 150 minutes a week. But without that guidance, it typically takes a long time to help, and in fact it most people just don’t do it. Who Metformin Helps Most The study showed that metformin helped the most among younger people, and with people who had a high body mass index (BMI) or a high fasting blood glucose level. It doesn’t help seniors much. But the biggest problem with metformin is to have your doctor prescribe it. Only 3.7 percent of insured adults who had a prediabetes diagnosis were taking it between 2010 and 2012, according to a study that the Annals of Internal Medicine published last year. This very low proportion is probably because the U.S. Food and Drug Administration hasn’t approved metformin — or any other drug — for prediabetes. While doctors are free to prescribe it “off label,” some of them are hesitant to do that. Some Side Effects Like any drugs, metformin sometimes has unwanted side effects. The mos Continue reading >>

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