Metformin use in prediabetes : Is earlier intervention better?

Journal article

Warrilow, Andrew, Somerset, Shawn, Pumpa, Kate and Fleet, Robert. (2020). Metformin use in prediabetes : Is earlier intervention better? Acta Diabetologica. 57, pp. 1359-1366. https://doi.org/10.1007/s00592-020-01559-9
AuthorsWarrilow, Andrew, Somerset, Shawn, Pumpa, Kate and Fleet, Robert
Abstract

Aim
The aim of this study was to investigate the effectiveness of metformin in diabetes prevention in a prediabetic population across a range of fasting plasma glucose (FPG) levels at baseline. A secondary aim was to assess the effectiveness of metformin in preventing diabetes in those participants where impaired fasting glucose (IFG) was relatively more pronounced as opposed to impaired glucose tolerance (IGT).

Methods
Participants randomised to metformin and placebo arms in the Diabetes Prevention Program study were stratified into cohorts according to level of FPG at baseline. Cumulative incidence of diabetes for the different cohorts was assessed. Change in FPG, insulin sensitivity, and levels of fasting insulin and proinsulin for the different cohorts were also calculated.

Results
The largest reductions in incidence of diabetes and FPG occurred within prediabetic persons with a higher level of FPG at baseline. Metformin was able to stabilise insulin sensitivity in every stratified sub-cohort except one. Sub-cohorts which had higher levels of insulin sensitivity at baseline experienced the largest increases in insulin sensitivity. Metformin reduced the incidence of diabetes by 43% (RR 0.57, CI 0.4–0.9) in those prediabetic persons whose IFG was more pronounced compared to a 26% (RR 0.74 CI 0.7–0.8) when all participants in the study were included.

Conclusion
The largest reductions in both incidence of diabetes and FPG occurred in prediabetic persons with a higher level of FPG at baseline. Metformin was able to stabilise insulin sensitivity and was more effective in persons with more pronounced IFG.

Keywordsmetformin; prediabetes; diabetes prevention; insulin sensitivity; insulin resistance
Year2020
JournalActa Diabetologica
Journal citation57, pp. 1359-1366
PublisherSpringer
ISSN0940-5429
Digital Object Identifier (DOI)https://doi.org/10.1007/s00592-020-01559-9
Scopus EID2-s2.0-85087133207
Research or scholarlyResearch
Page range1359-1366
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online30 Jun 2020
Publication process dates
Accepted12 Jun 2020
Deposited11 Aug 2021
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