The use of metformin for type 2 diabetes prevention: Observational multicenter study from Saudi Arabia

Modern-Day Management of the Dysglycemic Continuum: An Expert Viewpoint from the Arabian Gulf

Prediabetes is the first stage of a continuum that extends through the diagnosis of clinical type 2 diabetes towards long-standing diabetes with multiple comorbidities. The diagnosis of prediabetes provides an opportunity to interrupt the diabetes continuum at an early stage to ensure long-term optimization of clinical outcomes. All people with prediabetes should receive intervention to improve their lifestyles (quality of diet and level of physical activity), as this has been proven beyond doubt to reduce substantially the risk of conversion to diabetes. Additionally, a large base of clinical evidence supports the use of metformin in preventing or delaying the transition from prediabetes to clinical type 2 diabetes, for some people with prediabetes. For many years, guidelines for the management of type 2 diabetes focused on lowering blood glucose, with metformin prescribed first for those without contraindications. More recently, guidelines have shifted towards prevention of diabetes complications as the primary goal, with increased use of GLP-1 receptor agonists (or multi-agonist incretin peptides) or SGLT-2 inhibitors for patients with existing atherosclerotic cardiovascular disease, heart failure or chronic kidney disease. Access to these medications often remains challenging. Metformin remains a suitable option for initial pharmacologic intervention to manage glycemia for many people with prediabetes or type 2 diabetes along with other therapy to maintain control of blood glucose or to address specific comorbidities as the patient progresses along the diabetes continuum.

Evaluating the metformin use on type 2 diabetes prevention in high-risk populations in primary care

Purpose/Background

To identify the proportion of patients with prediabetes who have prescribed metformin and factors related to doing so as a preventive measure for diabetes in primary care at a Family Medicine Unit in northeastern Mexico.

Methods

This retrospective observational study included 372 adults who met the criteria for prediabetes diagnosis according to the American Diabetes Association. Data was collected from medical records from January 2020 to December 2021. Possible associations between the variables of interest and the prescription of metformin were tested via hypothesis tests, furthermore, binary logistic regression was performed.

Results

Nearly 85% of the patients met at least one criterion for receiving metformin according to ADA recommendations, but only 60% of them were prescribed this medication. Patients with metformin prescriptions differed from those without in aspects such as having a documented diagnosis of prediabetes in their medical records, a higher BMI, and higher glucose levels.

Conclusions

Almost one out of two patients with a high risk of type 2 diabetes are not treated with metformin as a preventive measure. Factors associated with metformin prescription included a high BMI, elevated baseline glucose levels, and a prediabetes diagnosis in the medical record. These findings suggest the need for studies to evaluate physicians' reasons for different treatments and implementation of recommendations for type 2 diabetes prevention in patients with prediabetes in primary health care.

Educational Model and Prevention on Prediabetes: A Systematic Review

BACKGROUND

Prediabetes is a reversible condition before the onset of Type 2 Diabetes Mellitus. Untreated condition of prediabetes will develop into diabetes and its complications. The prevalence of prediabetes has been emerging worldwide and has a considerable socioeconomic impact. The current study reviews the roles of early detection, educational models, life modification, and prophylaxis of individuals with prediabetes in preventing the progression of prediabetes into Type 2 Diabetes Mellitus and complications in the future.

METHODS

This study included published articles from several electronic databases. The obtained articles were limited to March 2023. Articles that were not open access and not in Indonesian or English were excluded. The protocol for this study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020.

RESULTS

Of 39627 articles, 39601 were excluded due to duplication and did not meet the eligibility criteria. At the final, there were 26 articles that were eligible for systematic review.

CONCLUSION

Prevention of the development of prediabetes into diabetes is essential. A comprehensive understanding and training on intensive lifestyle modification protocols from local and national experts in diabetes prevention through digital-based education models and linguistically and culturally approach can be considered. Intensive lifestyle modification and pharmacological approaches may improve the outcome. Regular monitoring of glycemic control is also important for early diagnosis of diabetes, especially in patients with special conditions.

Metformin use among obese patients with prediabetes in Qassim, Saudi Arabia: An observational study

Background and aims

The high prevalence of prediabetes and diabetes mellitus and its secondary complications in Saudi Arabia is a major healthcare concern. Evidence suggests that despite evidence-based efficacy and safety, metformin is underutilized in prediabetic obese patients. Thus, the aim of this study was to investigate the use of metformin in prediabetic obese patients in the Qassim region of Saudi Arabia.

Methods

Prediabetic patients' electronic health records were accessed and screened from 2017 to 2021. The inclusion criteria were patients with obesity (BMI ≥ 35) diagnosed with prediabetes, and who received metformin. Patients with chronic kidney disease and those using metformin for other diseases were excluded. The first major endpoint of this study was the rate of metformin use among obese, prediabetic individuals. The second major endpoint was the factors associated with metformin prescribing in our cohort. Descriptive statistics were used to report the primary and secondary outcomes. Data are presented as percentages, means, standard deviations (SDs), medians, and interquartile ranges, as appropriate. All analyses were conducted using Stata version 16.1.

Results

A total of 304 prediabetic patients were included in this study after screening the records of 1,789 patients. The average age was found to be 40, and the majority were female (72%). The average BMI was found to be 39.4 kg/m2, while the average HbA1c was 5.8%. In the entire sample, only 25 (8.22%) obese patients received metformin for diabetes prevention. Among obese patients with a BMI ≥ 30, 19 patients (8.7%) received metformin. Metformin users had higher odds of being on statins (OR 2.72, 95% CI 1.01 to 7.36; p = 0.049).

Conclusion

According to the study, metformin is not frequently prescribed to prediabetic obese individuals in the Qassim region of Saudi Arabia. This prevention strategy is a missed opportunity in the management of prediabetes in high-risk patients. Future studies are needed to investigate the root causes of the underuse of metformin and potential interventions to promote evidence-based practice in Saudi Arabia.

The Effectiveness of Metformin in Diabetes Prevention: A Systematic Review and Meta-Analysis

Diabetes mellitus is a growing global health concern, and prevention strategies play a crucial role in reducing its burden. Metformin has been widely studied as a potential intervention for diabetes prevention, but its overall effectiveness and impact on various populations remain unclear. This study aims to provide a comprehensive synthesis of the available evidence on the effectiveness of metformin in diabetes prevention. A systematic search was conducted in PubMed, Scopus, ScienceDirect, and Google Scholar for articles published from inception to June 2023. The reference lists of the included studies were also searched to retrieve possible additional studies. Any quantitative data were analyzed using Review Manager 5.4. A P-value of 0.05 was adopted as the significance threshold. Our analysis included 17 studies with a total sample size of 30,474. Our meta-analysis included two key analyses. First, the meta-analysis evaluating the effects of metformin on prediabetes demonstrated a significant reduction in the risk of progressing to type 2 diabetes mellitus (T2DM). The pooled odds ratio (OR) was 0.65 (95% confidence interval [CI] 0.53-0.80), indicating a 35% lower odds of developing T2DM among individuals with prediabetes who received metformin interventions compared to control groups. Secondly, the meta-analysis assessing the efficacy of metformin interventions in preventing T2DM yielded a significant reduction in the risk of developing the disease. The pooled risk ratio was 0.58 (95% CI 0.44-0.77), indicating a 42% lower risk of developing T2DM in individuals receiving metformin interventions compared to those in non-metformin intervention groups. These findings provide strong evidence for the effectiveness of metformin in preventing the progression of prediabetes to T2DM and reducing the overall incidence of the disease. The review demonstrated that metformin is effective in reducing the risk of developing diabetes mellitus among individuals at risk for the disease. The findings highlight the potential of metformin as a valuable intervention for diabetes prevention, particularly in high-risk populations.