Prediabetes, an intermediate stage between normal glucose regulation and diabetes, affects 1 in 3 adults in the US and approximately 720 million individuals worldwide.
Prediabetes 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%. In the US, approximately 10% of people with prediabetes progress to having diabetes each year. A meta-analysis found that prediabetes at baseline was associated with increased mortality and increased cardiovascular event rates (excess absolute risk, 7.36 per 10 000 person-years for mortality and 8.75 per 10 000 person-years for cardiovascular disease during 6.6 years). 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. Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years. 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.
Conclusions and Relevance
Prediabetes is associated with increased risk of diabetes, cardiovascular events, and mortality. First-line therapy for prediabetes is lifestyle modification that includes weight loss and exercise or metformin. Lifestyle modification is associated with a larger benefit than metformin.
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Accepted for Publication: March 3, 2023.
Corresponding Author: Sam Dagogo-Jack, MD, DSc, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, 920 Madison Ave, Ste 300A, Memphis, TN 38163 (firstname.lastname@example.org).
Conflict of Interest Disclosures: Dr Perreault reported receiving fees for consulting or speaking services from Novo Nordisk, Sanofi, Boehringer Ingelheim, AstraZeneca, Bayer, Lilly, NeuroBo, Medscape, WebMD, and UpToDate outside the submitted work. Dr Ji reported receiving fees for lecture presentations and consulting fees from AstraZeneca, Merck, Novartis, Novo Nordisk, Lilly, Roche, Sanofi-Aventis, and Takeda; and grants or research support from AstraZeneca, Merck, Novartis, Novo Nordisk, and Sanofi-Aventis outside the submitted work. Dr Dagogo-Jack reported serving as an investigator for AstraZeneca, Boehringer Ingelheim, and Novo Nordisk; receiving consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, Medtronic, Merck, and Sanofi; and having equity interests in Jana Care and Aerami Therapeutics outside the submitted work. No other disclosures were reported.
Funding/Support: Dr Echouffo-Tcheugui is supported, in part, by grant K23 HL153774 from the National Institutes of Health (NIH). Dr Perreault is supported, in part, by grant 1R18DK127003 from the NIH. Dr Dagogo-Jack is supported, in part, by grants R01 DK128129, R01 DK067269, and U01 DK048411 from the NIH.
Role of the Funder/Sponsor: The funding agencies supported the authors’ time and had no role in the collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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