If I Have Family History of Diabetes Can I Take Metaformin
Editorials: Controversies in Family Medicine
Should Adults with Prediabetes Be Prescribed Metformin to Prevent Diabetes Mellitus?
Yeah: High-Quality Testify Supports Metformin Utilize in Persons at High Risk
Am Fam Physician. 2019 Aug 1;100(3):134-135.
This is ane in a series of pro/con editorials discussing controversial issues in family medicine.
A surge in the prevalence of prediabetes1 highlights the importance of improving prediabetes sensation and engaging in strategies to lower the risk of blazon 2 diabetes mellitus. Based on prove from randomized controlled trials and observational studies, U.South. and international guidelines advocate for the apply of medications in add-on to intensive lifestyle interventions to prevent diabetes.2,3 Metformin, alpha-glucosidase inhibitors, orlistat (Xenical), glucagon-like peptide-i receptor agonists, and thiazolidinediones can all lower diabetes risk.iv Amid these, metformin has the strongest evidence of safety and effectiveness, making information technology the preferred pharmacologic option for diabetes prevention.four
Loftier-Quality Evidence Supports Metformin for Diabetes Prevention in Higher-Run a risk Patients
Several randomized controlled trials, including the Diabetes Prevention Program (DPP) study, have shown that metformin tin significantly lower incident diabetes adventure amongst overweight and obese patients with prediabetes.3 When compared with placebo, metformin had a relative chance reduction of 31% over three years, with a number needed to treat of 14.2,5 Three randomized trials (including the DPP study) reported accented risk reductions ranging from 4% to fourteen%.5 However, rates of diabetes progression vary significantly among individuals.
Although prevention is the ideal consequence, even delaying the onset of diabetes has several potential advantages. Compared with those who have prediabetes, individuals with diabetes require additional tests, procedures, and closer monitoring (i.east., retinal and foot examinations, more rigorous monitoring of blood pressure control); are at greater run a risk of diabetes-related complications; and may be more probable to face stigmas or discrimination.6 Currently, there is no U.S. Nutrient and Drug Administration indication for metformin use in prediabetes, in function because longitudinal follow-upward data have notwithstanding to demonstrate whether metformin employ tin can meliorate cardiovascular outcomes.7 Longer-term follow-upwardly in the DPP Outcomes Study may help determine whether treatment with metformin can lower the hazard of microvascular and macrovascular complications,7 and a large randomized clinical trial is underway to assess the consequence of metformin employ on cardiovascular outcomes among individuals with prediabetes and coronary artery disease.eight
Clinicians should consider prescribing metformin for diabetes prevention in adults at higher run a risk of incident diabetes, in whom the benefits are strongest. In clinical trials, metformin was more constructive in those who were younger than 60 years or more than obese (body mass index greater than 35 kg per m2) and in women with a history of gestational diabetes.four,seven When A1C level was used to define DPP eligibility and diagnosis of diabetes, metformin and intensive lifestyle intervention showed similar degrees of take a chance reduction.9 Thus, college A1C (i.e., 6.0% to half dozen.4%), but too other important risk factors, such as family history of diabetes, college fasting plasma glucose levels, and higher triglyceride levels, may predict greater risk of progression to diabetes.10 All of these chance factors should too be assessed when metformin is beingness considered for individual patients.x
Benefits of Metformin Use for Diabetes Prevention Outweigh the Risks
Metformin is a safe, tolerable, cost-effective, and perhaps cost-saving handling for prediabetes.eleven,12 In general, the biggest concern regarding metformin has been the potential risk of lactic acidosis. However, a Cochrane review of more than than 300 studies constitute no increased risk of lactic acidosis.13 Adverse effects of metformin include mild gastrointestinal symptoms and B12 deficiency.14 From an private perspective, fifty-fifty mild adverse effects may deter patients from using metformin, whereas the delay and/or prevention of diabetes may signify overwhelming benefit for others. From a societal perspective, the loftier prevalence of prediabetes underscores the importance of recommending metformin for higher-risk patients given its established rubber and price-effectiveness.
Metformin Use for Diabetes Prevention Is Aligned with Patient-Centered Principles of Care
To provide patient-centered care for whatever condition, it is critical to help patients understand direction options, weigh relative risks and benefits, and make choices that are aligned with their values and preferences. Initiating intensive lifestyle interventions is the first-line treatment for prediabetes, simply metformin should as well be presented as a safe and effective selection for higher-risk patients. Studies have shown that about patients consider both metformin and intensive lifestyle intervention equally adequate treatment options.fifteen
In summary, high-quality evidence supports metformin use for diabetes prevention among younger or more obese individuals or for women with a history of gestational diabetes. In these groups, the benefits of metformin likely outweigh the risks; therefore, clinicians should consider prescribing metformin, in addition to intensive lifestyle interventions, in accordance with patients' values and preferences. Family physicians accept the opportunity to provide more patient-centered care and reduce the burden of type 2 diabetes, one patient at a time.
Address correspondence to Tannaz Moin, MD, MBA, MSHS, at TMoin@mednet.ucla.edu. Reprints are not bachelor from the author.
Author disclosure: No relevant financial affiliations.
References
show all references
1. Gregg EW, Li Y, Wang J, et al. Changes in diabetes-related complications in the U.s., 1990–2010. Northward Engl J Med. 2014;370(sixteen):1514–1523. ...
two. Knowler WC, Barrett-Connor East, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Due north Engl J Med. 2002;346(half-dozen):393–403.
iii. Moin T, Schmittdiel JA, Flory JH, et al. Review of metformin use for type ii diabetes prevention. Am J Prev Med. 2018;55(iv):565–574.
four. American Diabetes Clan. Prevention or delay of type 2 diabetes: standards of medical intendance in diabetes—2018. Diabetes Intendance. 2018;41(suppl ane):S51–S54.
5. Lily M, Godwin Thousand. Treating prediabetes with metformin: systematic review and meta-analysis [published correction appears in Can Fam Doctor. 2010;56(i):18]. Tin Fam Physician. 2009;55(iv):363–369.
6. American Diabetes Association and National Institute of Diabetes, Digestive and Kidney Diseases. The prevention or delay of type 2 diabetes [published correction appears in Diabetes Intendance. 2002;25(5):947]. Diabetes Care. 2002;25(4):742–749.
seven. Aroda VR, Knowler WC, Crandall JP, et al. Metformin for diabetes prevention: insights gained from the Diabetes Prevention Programme/Diabetes Prevention Plan Outcomes Study. Diabetologia. 2017;threescore(9):1601–1611.
8. Investigation of Metformin in Pre-Diabetes on Atherosclerotic Cardiovascular OuTcomes (VA-Touch on). U.Southward. National Library of Medicine. Accessed September fifteen, 2018. https://clinicaltrials.gov/ct2/show/NCT02915198
9. Diabetes Prevention Program Research Group. HbA1c as a predictor of diabetes and as an effect in the diabetes prevention program: a randomized clinical trial. Diabetes Care. 2015;38(i):51–58.
x. Herman WH, Pan Q, Edelstein SL, et al. Touch of lifestyle and metformin interventions on the risk of progression to diabetes and regression to normal glucose regulation in overweight or obese people with impaired glucose regulation [published correction appears in Diabetes Intendance. 2018;41(4):913]. Diabetes Care. 2017;forty(12):1668–1677.
eleven. Diabetes Prevention Programme Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Written report. Diabetes Care. 2012;35(iv):731–737.
12. Diabetes Prevention Program Research Group. The 10-yr cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS [published correction appears in Diabetes Care. 2013;36(12):4173–4175]. Diabetes Care. 2012;35(4):723–730.
13. Salpeter SR, Greyber E, Pasternak GA, et al. Adventure of fatal and nonfatal lactic acidosis with metformin utilise in type two diabetes mellitus. Cochrane Database Syst Rev. 2010;(4):CD002967.
fourteen. Aroda VR, Edelstein SL, Goldberg RB, et al. Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016;101(four):1754–1761.
15. O'Brien MJ, Moran MR, Tang JW, et al. Patient perceptions about pre-diabetes and preferences for diabetes prevention. Diabetes Educ. 2016;42(vi):667–677.
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A collection of Editorials: Controversies in Family Medicine published in AFP is available at https://www.aafp.org/afp/pro-con.
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