Authors: Hostalek U, Gwilt M, Campbell I.
Lifestyle interventions will remain central to the management and prevention of non-communicable diseases, including type 2 diabetes. Successful deployment of lifestyle interventions requires considerable support, as most patients at risk of diabetes due to the prediabetic states of impaired glucose tolerance, impaired fasting glucose or gestational diabetes find it difficult to adhere to them sufficiently. Pharmacologic options will therefore be appropriate for many patients, alongside efforts to improve their lifestyles. Metformin remains the principal option for pharmacologic diabetes prevention, due to its proven efficacy in randomised diabetes prevention trials, its well understood tolerability and safety profiles, potential for cardiovascular protection for those who do go on to develop type 2 diabetes, and its low cost. Other treatments that have been shown to provide clinically significant protection from diabetes, such as thiazolidinediones, acarbose and basal insulin, have tolerability profiles that are challenging for populations with early dysglycemia. Management guidelines for diabetes prevention have acknowledged a role for metformin, particularly for heavier, younger subjects for whom lifestyle intervention has been insufficiently successful, but metformin has not yet been indicated for this purpose in most countries. This is changing now, as indicated for example by a new indication for metformin for diabetes prevention in the UK, for the convenient, once-daily, better tolerated extended release version. Metformin has been under use for diabetes prevention, and the availability of indications for diabetes prevention in more countries will facilitate its use in pragmatic regimes to protect people from type 2 diabetes.
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