Metformin vs. Lifestyle Changes for Prediabetes

For several years, there has been ongoing research and debate about when it’s appropriate to take drugs such as metformin to treat prediabetes. Since 2008, the American Diabetes Association has recommended metformin for certain cases of prediabetes, but as we noted in a piece here at Diabetes Flashpoints a couple of years ago, many doctors remain hesitant to follow these recommendations. And earlier this year, we looked at a study that compared the metformin with a lifestyle-based program for Hispanic women with prediabetes — and found the lifestyle program to be more beneficial, both for weight loss and for blood glucose control.

Now, a recent study appears to confirm that lifestyle programs can be more beneficial than simply taking a pill when you have prediabetes. Published last month in the journal Diabetes Care, the study looked at whether participants with prediabetes went on to develop diabetes, or returned to normal blood glucose levels, within a three-year period. In both cases, the researchers only included participants who adhered to their prescribed regimen, defined as losing at least 5% of their body weight six months into the lifestyle program, or reporting taking at least 80% of their medication six months into taking metformin.

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As described in a Physician’s Briefing article on the study, participants who were deemed to be at lowest risk for developing diabetes at the beginning of the study reduced this risk by 8% by participating in the lifestyle program. Those in the metformin group, however, experienced no reduction in risk compared with a third group that took placebos (inactive pills). Low-diabetes-risk members of the lifestyle group were 35% more likely than those in the placebo group to return to normal blood glucose levels, while those in the metformin group were 17% more likely to do so.

The lifestyle program was also shown to be more beneficial among participants deemed to be at highest risk for developing diabetes. Among these participants, those in the lifestyle group reduced their risk by 39% compared with the placebo group, while those in the metformin group reduced their risk by 25%. Those in the lifestyle group were 24% more likely to return to normal blood glucose levels, and those in the metformin group were 11% more likely to do so, than members of the placebo group.

One potential limitation of this study is that weight loss was used as a measurement of adherence to the lifestyle program, which may not be equivalent to measuring adherence to taking pills since it’s looking at an outcome, rather than a behavior. But assuming that participating in most of the lifestyle program was virtually guaranteed to result in some weight loss, this study shows just how effective such a program can be at reducing progression to diabetes — and even restoring blood glucose to normal levels. Of course, it’s possible that combining a lifestyle program with metformin could result in even greater benefits than each one individually.

What’s your take on this study — should everyone with prediabetes participate in a lifestyle-based program to reduce their risk of developing diabetes? Or is it more practical to simply prescribe a drug and give lifestyle recommendations that people may or may not follow? Have you ever been given a choice between metformin and lifestyle changes to control your prediabetes or diabetes? If so, what course did you take, and why? Leave a comment below!

Want to learn more about prediabetes? Read “Prediabetes: What to Know” and “Stopping Prediabetes In Its Tracks.”