Can A Pill Prevent Diabetes? Prediabetes Treatment

Can Metformin Prevent Diabetes?

Summary: Prediabetes treatment options can include an inexpensive pill called metformin and lifestyle changes. The latter is shown to be the best solution. [Author: Brady Hartman. This article first appeared on the website ]

What Is Prediabetes?

Prediabetes is an early diagnosis of diabetes—you can think of it as a warning sign. It’s when your blood-sugar level is higher than normal, but it’s not high enough to be considered type 2 diabetes.

Prediabetes is an indication that you could develop diabetes if you don’t make some lifestyle changes. Without treatment, prediabetics are at much greater risk of developing full-blown diabetes. In fact, 5% to10% of prediabetics convert to full-blown diabetes each year. Think of prediabetes as a warning sign.
There is good news, however. You can help prevent the disease from developing into type 2 diabetes. Prediabetes treatment options include a generic tablet called metformin and lifestyle changes.
Lifestyle changes include eating healthy food, losing weight, staying at a healthy weight, and being physically active.  These changes are the best way to bring your blood glucose level back into the normal range.
For those who fail at lifestyle changes, doctors sometimes prescribe a tablet called metformin. As a prediabetes treatment, metformin is inferior to lifestyle changes. However, metformin is better than no treatment at all.

Prediabetes Treatments Compared

For people with prediabetes, the two ways to reduce the risk of type 2 diabetes are lifestyle changes and medications.  With a little exercise, a change in diet or even tablets, such as metformin, costing 15 cents each, prediabetics can control and even reverse the condition. That’s right, treat it until it goes away completely.

Over the years, different research studies have evaluated the effectiveness of various prediabetes treatments. The largest studies are the 2002 Diabetes Prevention Program, a 2012 review published in The Lancet, and the Merck systematic review of prediabetes treatments.

DPP Compares Prediabetes Treatments

Which prediabetes treatment is better at preventing type 2 diabetes – metformin or lifestyle changes? The authors of the Diabetes Prevention Program (DPP) set up an experiment to answer the question.

The 2002 Diabetes Prevention Program (DPP) was a major clinical research study of prediabetics. The researchers wanted to discover which prediabetes treatment was superior in preventing or delaying the onset of type 2 diabetes.  They compared three treatments, including weight loss with lifestyle changes, treatment with metformin, and doing nothing.

At the beginning of the DPP, all 3000 plus study participants were overweight and had prediabetes, that is, they had blood sugar levels higher than normal but not high enough for a diagnosis of type 2 diabetes. The researchers randomly divided the participants into three different prediabetes treatment groups.

Prediabetes Treatment Group 1 – Lifestyle Changes

Intervention: The lifestyle intervention group received intensive training in diet, physical activity, and intensive counseling in lifestyle modification. By eating fewer calories and less fat as well as exercising for a total of 150 minutes a week, the lifestyle group aimed to lose 7 percent of their body weight and maintain that loss.

Results: At the end of the study, the researchers found that this group reduced their risk of developing type 2 diabetes by 58 percent. This finding was true across all ethnic groups and for both women and men. About 5 percent of the lifestyle intervention group developed type 2 diabetes each year during the study period.

There was even better news for older adults. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

Lifestyle changes worked particularly well for participants aged 60 and older, who reduced their risk by 71 percent.

Prediabetes Treatment Group 2 – Metformin

Intervention: The second group only received medication. They took 850 mg of metformin twice a day. They also received information about diet and exercise but no intensive motivational counseling.

Results: The researchers found that about 7.8 percent of the metformin group developed type 2 diabetes each year during the study. According to the NIDDK:

“Participants taking metformin reduced their risk of developing diabetes by 31 percent.”  Adding: “Metformin was effective for both men and women, but it was least effective in people aged 45 and older.”

While drug therapy was less effective for some, the researchers found that prediabetes treatment with metformin was most effective in young overweight people. The NIDDK stated that metformin therapy was:

most effective in people 25 to 44 years old and in those with a body mass index [BMI] of 35 or higher, meaning they were at least 60 pounds overweight.

Prediabetes Group 3  – No Treatment

Intervention: The third group was a control group and received no prediabetes treatment. They were given placebo pills instead of metformin. They also received information about diet and exercise but no intensive motivational counseling.

Results:  For the group receiving the placebo, 11 percent developed type 2 diabetes each year during the study.

The Lancet Evaluates Prediabetes Treatments

A later study, published in the journal The Lancet, also investigated the various prediabetes treatments, including lifestyle changes or medications such as metformin.  The 2012 Lancet study noted that any prediabetes treatment was more effective than doing nothing at all.  The study’s authors found that with lifestyle changes, people with prediabetes can reduce their risk of developing full-blown diabetes by about 40% to 70%.  Lifestyle modification was more effective than just taking metformin.

Merck Study Evaluates Prediabetes Treatments

In 2015, researchers from pharmaceutical giant Merck performed a systematic review investigating the effectiveness of various prediabetes treatments at preventing type 2 diabetes. The authors concluded:

A substantial proportion of subjects with prediabetes are likely to benefit from a combination of lifestyle intervention and pharmacologic intervention [metformin] to prevent or delay the onset of type 2 diabetes. The current evidence base supports a role for metformin in diabetes prevention, combined with counseling, to achieve a healthier lifestyle.

The report was written by two employees of the pharmaceutical giant, Merck which markets several formulations of metformin. Funding bias can be ruled out. First of all, metformin is a low-cost generic with small margins. Generic manufacturers don’t have a monopoly on the drug and have less to gain by overstating the facts. Second of all, and most importantly, Merck doesn’t market metformin as a prediabetes treatment.

Merck sells metformin as an add-on to a more profitable drug, sitagliptin. Merck markets two blockbuster diabetes drugs, Januvia and Janumet. Both are used to lower blood sugar levels in type 2 diabetics. The active ingredient in Januvia is sitagliptin. Janumet is a combination of metformin and sitagliptin.

The authors of the Merck study analyzed the various prediabetes treatments and confirmed the findings of the DPP and the Lancet studies, writing:

Lifestyle interventions aimed at inducing weight loss, pharmacologic treatments (metformin, thiazolidinediones, acarbose, basal insulin and drugs for weight loss) and bariatric surgery have all been shown to reduce the risk of progression to type 2 diabetes in prediabetic subjects.

They  provided a strong rationale for using metformin as a prediabetes treatment, stating:

…lifestyle interventions are difficult for patients to maintain and the weight loss achieved tends to be regained over time.

The authors explained the mechanism of action and safety of metformin as a prediabetes treatment, adding:

Metformin enhances the action of insulin in liver and skeletal muscle, and its efficacy for delaying or preventing the onset of [type 2] diabetes has been proven in large, well-designed, randomized trials, such as the Diabetes Prevention Program and other studies. Decades of clinical use have demonstrated that metformin is generally well-tolerated and safe.

Prediabetes treatment saves lives. Don’t let prediabetes steal years from your life.
Don’t let prediabetes steal years from your life. Photo: Pexels.

Prediabetes Treatment With Metformin

Despite the evidence supporting metformin as a prediabetes treatment for the prevention of diabetes, the drug is not fully approved for this purpose. The FDA approves the metformin for off label use in the treatment of prediabetics.

Metformin is approved for type 2 diabetes prevention in a few countries. Only Turkey, Poland, and The Philippines permit using metformin in prediabetes treatment.

One unexpected benefit of the drug is reduced cancer risk. Research has shown that metformin prevents cancer as explained in the linked article.

Doubts That Metformin Prevents Type 2 Diabetes

No one disagrees that metformin lowers the blood sugar levels of prediabetics. The doubters argue that metformin reduces blood sugar levels so efficiently, that the drug masks the diagnosis of diabetes, rather than prevent the progression of the disease.

Decades long clinical trials are required to determine if prediabetes treatment with metformin prevents the underlying progression to full-blown diabetes.

Best Prediabetes Treatment

The evidence is strong.  While metformin can help prevent type 2 diabetes in some prediabetics, losing weight with lifestyle changes has been shown to be the most effective prediabetes treatment. According to the CDC:

“If you have prediabetes, losing a small amount of weight if you’re overweight and getting regular physical activity can lower your risk for developing type 2 diabetes.”

How Much Weight –  losing weight can reduce the risk of developing type 2 diabetes, and make you healthier in the process. The weight loss target depends on your starting point. Most organizations recommend losing weight until a healthy weight is achieved and then maintaining that weight.  The CDC recommends:

“A small amount of weight loss means around 5% to 7% of your body weight, just 10 to 14 pounds for a 200-pound person.”

Regular Physical Activity – Exercise also helps with weight loss. The CDC defines regular physical activity as  “getting at least 150 minutes a week of brisk walking or a similar activity. ”

Ways To Lose Weight –  A diet heavy in fruits and vegetables is not only healthy – it also helps you to lose weight. The fiber fills you up, so you don’t feel hungry. As an added benefit, studies have shown that a diet rich in fruits and vegetables help you live longer.

Two related articles show you how to eat healthily. The first article shows you the health benefits of a diet rich in fruit in vegetables – a diet which can help you to reduce blood sugar and lose weight. In fact, the US News and World Report ranks the fruit-and-veggie-rich DASH Diet plan as among the best. The second article shows you how to incorporate ten servings of fruits and vegetables into your day.

Take Home Message 

For preventing type 2 diabetes, lifestyle changes are about twice as effective as metformin. Metformin is an approved off-label prediabetes treatment and has been shown to be effective in some people. Treating prediabetes is inexpensive and prevents the disease from stealing years of your life.

Companion Articles

  1. For those who are not prediabetic, and still want to prevent type 2 diabetes or prediabetes, this companion article shows you how to delay or prevent type 2 diabetes.
  2. If you would like to learn more about prediabetes, see this article.

Prediabetes Treatment Resources

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Article References

  1. Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 2002; 346:393–403. Available Online.
  2. The National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Prevention Program (DPP). Online publication. Retrieved 08/6/2017. Available Online. 
  3. Adam G Tabák, MD, Christian Herder, Ph.D., Wolfgang Rathmann, MD, Eric J Brunner, Ph.D., Prof Mika Kivimäki, Ph.D. Prediabetes: A high-risk state for developing diabetes. 2012. The Lancet, Volume 379, Issue 9833, 2279-2290. Available Online.
  4. Ulrike Hostalek, Mike Gwilt, Steven Hildemann. Therapeutic Use of Metformin in Prediabetes and Diabetes Prevention. Drugs. 2015; 75(10): 1071–1094. doi:  10.1007/s40265-015-0416-8. Available Online.


Diagnosis, Advice, and Treatment:  This article is intended for informational and educational purposes only and is not a substitute for professional medical advice. The information provided in this report should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Consult a licensed physician for the diagnosis and treatment of any and all medical conditions. Call 911, or the equivalent emergency hotline number, for all medical emergencies. As well, consult a licensed physician before changing your diet, supplement or exercise programs.  Photos, External Links & Endorsements: This article is not intended to endorse companies, organizations or products. Links to external websites, depiction/mention of company names or brands, are intended only for illustration and do not constitute endorsements.

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