What are the treatment options for prediabetes (impaired glucose regulation)?

From the Guidelines

Prediabetes treatment should prioritize lifestyle modifications, with metformin considered for high-risk individuals, as evidenced by the most recent guidelines 1. The primary approach to treating prediabetes involves lifestyle changes, including a structured weight loss program aiming for a 5-7% reduction in body weight through a combination of calorie restriction and regular physical activity, such as at least 150 minutes of moderate-intensity exercise weekly 1.

• Adopt a diet rich in vegetables, fruits, whole grains, lean proteins, and healthy fats
• Limit processed foods, sugary beverages, and refined carbohydrates Metformin (500-850 mg once or twice daily) may be prescribed for those at high risk, particularly individuals under 60 with BMI ≥35 kg/m², those with progressively rising A1C despite lifestyle changes, or women with a history of gestational diabetes 1. Regular monitoring is essential, with A1C tests every 6-12 months to track progress, as recommended by recent guidelines 1. These interventions work by improving insulin sensitivity, reducing hepatic glucose production, and preserving beta-cell function, ultimately preventing or delaying progression to type 2 diabetes, which occurs in approximately 5-10% of people with prediabetes annually if left untreated 1. Key considerations include:
• Screening for and treatment of modifiable risk factors for cardiovascular disease, as people with prediabetes are at increased risk 1
• Periodic measurement of vitamin B12 levels in metformin-treated patients, especially in those with anemia or peripheral neuropathy 1
• Referral for tobacco cessation and evaluation for other cardiovascular risk factors, such as hypertension and dyslipidemia 1

From the Research

Prediabetes Treatment Overview

• Prediabetes is a condition where blood glucose levels are higher than normal but not high enough to be classified as diabetes, affecting 1 in 3 adults in the US and approximately 720 million individuals worldwide 2.
• It is defined by a fasting glucose level of 100 to 125 mg/dL, a glucose level of 140 to 199 mg/dL measured 2 hours after a 75-g oral glucose load, or glycated hemoglobin level (HbA1C) of 5.7% to 6.4% or 6.0% to 6.4% 2.

Lifestyle Modification

• 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 2.
• The American Diabetes Association nutrition and lifestyle recommendations for prediabetes and type 2 diabetes focus on losing 7% of body weight and increasing physical activity to at least 150minperweek 3.
• A lifestyle intervention aimed at 7% weight loss and 150min of activity per week reduced diabetes incidence by 58% after 2.8years of follow-up and resulted in sustained improvements in hemoglobinA1c, blood pressure and lipid levels 3.

Medication

• Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years 2.
• Metformin is most effective for women with prior gestational diabetes and for individuals younger than 60 years with body mass index of 35 or greater, fasting plasma glucose level of 110 mg/dL or higher, or HbA1c level of 6.0% or higher 2.

Exercise and Physical Activity

• Aerobic exercise training, including continuous moderate intensity and high-intensity interval training, can improve glycemic control, visceral adiposity, and aerobic fitness in persons with prediabetes 4.
• A 12-wk exercise program involving both resistance training and either high-intensity interval training or continuous training results in improved glycemic control, visceral adiposity, and aerobic fitness in persons with prediabetes 4.

Cost-Effectiveness

• Lifestyle intervention is an efficacious, safe, and cost-effective measure to reduce the risk of progression to type 2 diabetes in people diagnosed with prediabetes 5.
• Costs per quality-adjusted life-year were lower when the benefits of lifestyle intervention were analyzed over a lifelong time horizon compared to only the period of lifestyle intervention (three years) or to modeling over a ten-year period 5.