Lifestyle Intervention vs. Metformin for Prediabetes

According to the American Diabetes Association, about 86 million Americans have prediabetes — a number that is most likely rising every day. The recent, sustained rise in cases of prediabetes — defined as having elevated blood glucose that isn’t high enough to qualify as diabetes — has led many researchers to try to find ways to reverse this troubling trend.

One therapy that has shown promise for prediabetes is the oral diabetes drug metformin. As we noted here at Diabetes Flashpoints a couple of years ago, the American Diabetes Association recommends metformin for certain cases of prediabetes, and has done so since 2008. But some studies — including one we wrote about in 2011 — have found that lifestyle intervention programs may have a more beneficial effect for people with prediabetes than metformin.

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In a recent study, researchers sought to investigate the weight-loss benefits of metformin versus lifestyle intervention in Hispanic women, a group in which this issue hadn’t been studied before. Published last month in the American Journal of Preventive Medicine, the study included 92 women with an average age of 45 who were randomly assigned to one of three groups: metformin, lifestyle intervention, and standard care (which consisted of monitoring and recommendations to exercise and lose weight).

As noted in a Healio article on the study, the lifestyle intervention program consisted of sessions with community health workers in which participants were coached on how to set goals, control cravings, and problem-solve to improve their diet and get at least 150 minutes of exercise per week. Members of the metformin group took 850 milligrams of the drug twice daily.

Over 12 months, members of the lifestyle intervention group lost an average of 4 kilograms (about 9 pounds), or 5% of their body weight. Members of the metformin group lost an average of 0.9 kilograms (about 2 pounds), or 1.1% of their body weight, and members of the standard care group gained an average of 0.8 kilograms (about 1.75 pounds), or 0.9% of their body weight. Members of the lifestyle intervention group also had a slightly lower HbA1c level (a measure of long-term blood glucose control) than women in the other two groups.

It may be the case, of course, that both taking metformin and participating in a lifestyle intervention program would yield greater benefits than doing either one by itself. But this study shows that at least among Hispanic women — and in line with results that have been seen with other groups — lifestyle intervention programs have substantial benefits for prediabetes.

What’s your take on this study — if you have prediabetes, would you like to participate in a lifestyle intervention program? Do you think these programs should be more widely offered, and covered by insurance, even if they’re more expensive than taking metformin? Do you think that participating in such a program might have helped prevent your developing Type 2 diabetes? Leave a comment below!

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