Key News in Family Medicine March 29, 2019 (12 of 13)

Metformin has reduced the development of diabetes over 15 years, particularly in people with higher fasting blood glucose levels or baseline HbA1c levels and in women with a history of gestational diabetes, the authors said. researchers.

In the 1990s, the Diabetes Prevention Program (DPP) recruited a cohort at very high risk of diabetes and badigned patients to receive either metformin or a lifestyle intervention program to treat The major identified risk factors for diabetes, Dr. David Nathan, director, MGH Diabetes Center in Boston, MA, told Reuters Health.

This trial, which ended in 2002, "showed a major effect of both treatments on reducing the development of diabetes: 58% reduction with the lifestyle program and 31% with metformin", he declared by e-mail.

"The study of the PDP population has continued for another 15 years," he noted. "During this time, the intervention on lifestyle was recommended for all participants and metformin, which is currently not approved by the FDA for prevention purposes, was continued in the group. initial treatment with metformin. "

"The main findings of this study show that metformin reduced the development of diabetes by 17% by using blood glucose results to define diabetes," he said. "When diabetes was defined with hemoglobin A1c, the reduction was even greater: 36%."

Dr. Nathan and his colleagues conducted a post-randomization follow-up of more than 2,000 people initially badigned to placebo or metformin 850 mg twice daily in the PDP. Metformin sufferers continued to take this medication from 2002 to date as part of the ongoing study on the results of the diabetes prevention program.

As reported online March 15 Diabetic treatments, the average cumulative exposure to metformin during follow-up was 8.75 years. As noted by Dr. Nathan, metformin has reduced the incidence of diabetes (badessed by the risk ratio [HR]) versus placebo by 17% or 36% depending on glucose or HbA1c levels, respectively.

The beneficial effect of metformin on the development of diabetes defined by glucose was greater in women with a history of gestational diabetes (HR, 0.59, difference in rate, -4.57 cases / 100 years). persons) compared to paroecious women without gestational diabetes (HR, 0.94, rate differences, -0.38 cases / 100 person-years).

Metformin also had greater effects in patients with higher fasting fasting glucose levels. With the development of diabetes based on HbA1c, metformin was found to be more effective in terms of rate difference in women whose initial HbA1c level was higher. The difference in rates was -1.03 cases / 100 person-years in women whose baseline HbA1c was <6.0% (42 mmol / mol) and -3.88 cases / 100 years -persons in women whose initial HbA1c level was between 6.0 and 6.4%.

"Although some studies have demonstrated the beneficial effects of other drugs," said Dr. Nathan, "most have had a variety of side effects and side effects that make them less attractive for diabetes prevention, and they are all considerably more expensive. "

"Keeping in mind that drugs used for prevention purposes must be particularly safe and well tolerated, metformin is currently the only drug that" matches the bill "and should be considered as a precautionary measure. he concluded. "The American Diabetes Association concurred with this conclusion in its recommendations."

Dr. Charmaine Rochester-Eyeguokan of the Faculty of Pharmacy at the University of Maryland in Baltimore said in an email to Reuters Health: "There is currently no comparative trial of all these agents and they have demonstrated . "

Like Dr. Nathan, she said: "No drug seems to be as effective as metformin or a lifestyle modification, and metformin also has other benefits, including low cost and reduced cardiovascular risk. . "

"Current evidence suggests that metformin is safe, effective, tolerable and an economic intervention to prevent or delay type 2 diabetes," said Dr. Rochester-Eyeguokan, who did not participate in the study. ;study. "Therefore, policy makers, providers, and payers should work together to understand the barriers to meaningful use and advocate for the FDA's approval of this agent for the prevention or delay of type 2 diabetes." in high-risk groups. "

"Clinicians should monitor vitamin B12 in patients treated chronically with metformin," she added. "Lifestyle changes should be strongly encouraged, even more than metformin, in all patients with prediabetes."

-Marilynn Larkin