From the Guidelines
Prediabetes treatment should primarily focus on lifestyle modifications, including regular physical activity and dietary changes, to prevent progression to type 2 diabetes, with metformin considered for high-risk patients, as evidenced by the Diabetes Prevention Program trial 1.
Key Recommendations
- Regular physical activity, aiming for at least 150 minutes of moderate exercise weekly, is crucial for preventing progression to type 2 diabetes 1.
- Dietary changes should emphasize whole foods, reduced refined carbohydrates, and portion control to achieve modest weight loss of 5-7% of body weight 1.
- Increasing fiber intake through vegetables, fruits, and whole grains, while limiting processed foods, sugary beverages, and excessive alcohol, is recommended 1.
- Regular blood glucose monitoring helps track progress, with a target fasting glucose below 100 mg/dL 1.
- For some patients, especially those with BMI ≥35, family history of diabetes, or advancing age, medication may be considered, with metformin (typically starting at 500 mg daily, potentially increasing to 1000 mg twice daily) being the most commonly prescribed option 1.
Lifestyle Modifications
Lifestyle modifications have been shown to significantly decrease the rate of diabetes onset, with intensive lifestyle modification programs reducing the rate by 58% after 3 years 1.
Medication
Metformin has been demonstrated to be effective in preventing progression to diabetes, with the Diabetes Prevention Program trial showing a 7.8% progression rate in patients taking metformin compared to 11.0% in the placebo group 1.
Follow-up
Regular follow-up with healthcare providers every 3-6 months allows for monitoring progress and adjusting the treatment plan as needed 1.
From the Research
Treatment Options for Prediabetes
- Intensive lifestyle modification, consisting of calorie restriction, increased physical activity (≥150 min/wk), self-monitoring, and motivational support, has been shown to decrease the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period 2.
- Metformin has also been found to decrease the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years, and 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.
- Lifestyle modification is associated with a larger benefit than metformin in preventing the progression to diabetes 2.
Importance of Healthcare Provider Recommendations
- Receiving a healthcare provider's recommendation for lifestyle modifications is associated with increased adherence to healthier behaviors, such as weight control and diet modification, among adults with prediabetes 3.
- Healthcare providers play a crucial role in promoting adherence to a healthier lifestyle among individuals with prediabetes 3.
Lifestyle Interventions for Prediabetes
- Lifestyle interventions, including weight loss, active lifestyle, and healthy diet, can effectively prevent or delay the development of diabetes and its associated complications 4, 5.
- Increasing physical activity has been shown to be inversely associated with the incidence of diabetes, and is a key component of lifestyle modification initiatives for patients with prediabetes and type 2 diabetes mellitus 6.
- Combining physical activity with a healthy diet and other lifestyle modifications can result in significant weight reduction and cardiometabolic benefits 6.