Diagnosis and Management of Prediabetes: A Review.
Level 5 - mechanism / opinion, no new human data
Narrative clinical review synthesizing existing literature
PubMed 37039787 · doi:10.1001/jama.2023.4063
What was done
Narrative clinical review synthesizing evidence on the epidemiology, diagnostic criteria, associated mortality and cardiovascular risks, and preventive interventions (lifestyle modification and metformin) for prediabetes.
What was found
Prediabetes affects 1 in 3 US adults and approximately 720 million individuals worldwide, with approximately 10% progressing to diabetes each year in the US. Baseline prediabetes was associated with an excess absolute risk of 7.36 per 10,000 person-years for mortality and 8.75 per 10,000 person-years for cardiovascular disease over 6.6 years. Intensive lifestyle modification (calorie restriction, at least 150 minutes per week of physical activity, self-monitoring, and motivational support) decreased diabetes incidence by 6.2 cases per 100 person-years over 3 years. Metformin decreased diabetes risk by 3.2 cases per 100 person-years over 3 years, showing greatest efficacy in individuals younger than 60 years with BMI of 35 or greater, fasting glucose of 110 mg/dL or higher, HbA1c of 6.0% or higher, or prior gestational diabetes.
Why it matters
Lifestyle intervention provides roughly double the absolute risk reduction of metformin for preventing progression to diabetes and remains the recommended first-line therapy.
Limits
As a narrative review, the abstract does not specify systematic literature search criteria, study selection methods, or total pooled sample size. The abstract does not provide effect sizes for lifestyle or metformin on hard clinical endpoints such as cardiovascular events or mortality.
Cited by
- context Approximately 115 million adults in the United States currently have pre-diabetes.