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Review of Metformin Use for Type 2 Diabetes Prevention

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Moin, Tannaz, Schmittdiel, Julie A., Flory, James H., Yeh, Jessica, Karter, Andrew J., Kruge, Lydia E., Schillinger, Dean, Mangione, Carol M. +2 more·2018·American Journal of Preventive Medicine
DOI 10.1016/j.amepre.2018.04.038PMC PMC6613947
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Abstract

Context Prediabetes is prevalent and significantly increases lifetime risk of progression to type 2 diabetes. This review summarizes the evidence surrounding metformin use for type 2 diabetes prevention. Evidence acquisition Articles published between 1998 and 2017 examining metformin use for the primary indication of diabetes prevention available on MEDLINE. Evidence synthesis Forty articles met inclusion criteria and were summarized into four general categories: (1) RCTs of metformin use for diabetes prevention (n=7 and n=2 follow-up analyses); (2) observational analyses examining metformin use in heterogeneous subgroups of patients with prediabetes (n=9 from the Diabetes Prevention Program, n=1 from the biguanides and the prevention of the risk of obesity [BIGPRO] trial); (3) observational analyses examining cost effectiveness of metformin use for diabetes prevention (n=11 from the Diabetes Prevention Program, n=1 from the Indian Diabetes Prevention Program); and (4) real-world assessments of metformin eligibility or use for diabetes prevention (n=9). Metformin was associated with reduced relative risk of incident diabetes, with the strongest evidence for use in those at highest risk (i.e., aged <60 years, BMI ≥35, and women with histories of gestational diabetes). Metformin was also deemed cost effective in 11 economic analyses. Recent studies highlighted low rates of metformin use for diabetes prevention in real-world settings. Conclusions Two decades of evidence support metformin use for diabetes prevention among higher-risk patients. However, metformin is not widely used in real-world practice, and enhancing the translation of this evidence to real-world practice has important implications for patients, providers, and payers.

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  • Treatment effects of metformin may vary depending on risk levels of the individual.

    “treatment effects may vary depending on risk levels of the individual. 9”

    From Metformin Prescription Rates for Patients with Prediabetes (2022) · cites this paper as [9]

  • Diabetes incidence can be reduced through effective preventive interventions, such as participation in intensive lifestyle change programs or pharmacotherapy such as metformin.

    “Studies have shown diabetes incidence can be reduced through effective preventive interventions, such as participation in intensive lifestyle change programs (LCP) like the National Diabetes Prevention Program (National DPP) lifestyle change program, or with pharmacotherapy such as metformin. 7 -12”

    From Metformin Prescription Rates for Patients with Prediabetes (2022) · cites this paper as [9]

  • There is no FDA indication for metformin use for diabetes prevention.

    “there is no Food and Drug Administration (FDA) indication for metformin use for diabetes prevention”

    From Metformin Prescription Rates for Patients with Prediabetes (2022) · cites this paper as [9]

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Authors
Moin, T., Schmittdiel, J. A., Flory, J. H., Yeh, J., Karter, A. J., Kruge, L. E., Schillinger, D., Mangione, C. M., Herman, W. H., & Walker, E. A.
Affiliations
  • University of California, Los Angeles (US)
  • Kaiser Permanente (US)
  • Weill Cornell Medicine (US)
  • Johns Hopkins University (US)
  • Albert Einstein College of Medicine (US)
  • University of California, San Francisco (US)
  • University of Michigan (US)
Corresponding author
Moin, Tannaz
ORCID
Venue
American Journal of Preventive Medicine
Publisher
Elsevier BV
Published
2018-10
Volume
55
Issue
4
Pages
565-574
ISSN
0749-3797 (ISSN-L)
DOI
10.1016/j.amepre.2018.04.038
PMC
PMC6613947
OpenAlex
W2885846351
Cited by
75
References
17
Citations by year
2026: 6 · 2025: 8 · 2024: 6 · 2023: 9 · 2022: 13 · 2021: 14 · 2020: 9 · 2019: 7 · 2018: 3
FWCI
1.27
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • American Journal of Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Kaiser Permanente
  • National Institutes of Health (UL1TR000124, P30-AG02-1684, DK 020541, DK092924)
  • Centers for Disease Control and Prevention (UL1TR000124, U18DP006140)
  • Agency for Healthcare Research and Quality (K08‐HS023898)
  • National Institute on Aging (P30AG021684)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R18DK105464, DK-020541, P30DK079637, P30DK098722, P60DK020541, DK111022, P30DK092926, P30DK092924, P30DK020541, P30DK111022)
  • National Center for Advancing Translational Sciences
  • Clinical and Translational Science Institute, University of California, Los Angeles (UL1TR000124)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
Keywords
metformin, type 2 diabetes prevention, prediabetes, biguanides, Diabetes Prevention Program, cost-effectiveness, gestational diabetes mellitus, obesity, real-world prescribing, evidence translation
MeSH terms
Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Metformin, Obesity, Prediabetic State, Pregnancy, Risk Factors, Diabetes, Gestational

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