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Prediabetes: Which Treatment Should I Use?

Prediabetes: Which Treatment Should I Use?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prediabetes: Which Treatment Should I Use?

Get the facts

Your options

  • Make major lifestyle changes to help prevent type 2 diabetes.
  • Take the medicine metformin to help prevent type 2 diabetes.

Key points to remember

  • If you have prediabetes, your blood sugar is higher than it should be. You are more likely to get type 2 diabetes.
  • Major lifestyle changes can help prevent diabetes in people with prediabetes. These changes include losing weight, getting more exercise, and eating healthier.
  • The medicine metformin can also help prevent diabetes in people with prediabetes. But metformin doesn't work as well as major lifestyle changes.
  • Even if you take metformin, it is important to make as many healthy lifestyle changes as you can.
FAQs

What is prediabetes?

Prediabetes means that your blood sugar is higher than it should be, but not high enough to be diabetes. Most people who get type 2 diabetes have prediabetes first.

Why should you avoid diabetes?

Diabetes is a long-term illness that can have a big impact on your life. If you get it, you'll probably have to make some changes. For example, you may have to carefully watch what you eat, take medicine every day, and watch for other health problems.

Over time, diabetes can harm your eyes, nerves, and kidneys. It can damage your blood vessels. This can lead to heart disease, heart attack, and stroke. You could also have nerve damage. In your feet, this nerve damage can cause slow healing and pain when you walk. Your immune system may become weak and less able to fight infections.

How do you treat prediabetes?

The main treatment is to lower blood sugar with healthy lifestyle changes. The medicine metformin can also lower blood sugar. Research shows that people who are able to make major lifestyle changes can have more success lowering their blood sugar than people who take metformin.1 Some people may choose to take metformin and also make major lifestyle changes.

What lifestyle changes do you need to make?

Studies show that these three changes make getting diabetes less likely:1

  • Losing 7% or more of your weight, if you are overweight. If you weigh 200 pounds, losing 7% of your weight means losing 14 pounds.
  • Getting at least 2½ hours (150 minutes) of moderate activity a week. Moderate activity gets your heart pumping. It includes walking quickly, playing basketball, or dancing fast.
  • Eating a diet low in calories and saturated fat.

To prevent diabetes, you have to make major lifestyle changes. If you just change what you eat and get a little more exercise for a few months, it won't be enough.

What are the benefits and risks of using lifestyle changes to treat prediabetes?

Lifestyle changes can:

  • Help you lower blood sugar and prevent diabetes.
  • Help control or prevent high blood pressure, high cholesterol, and heart disease.
  • Help you feel better overall.

If you start slowly and follow your doctor's advice, there are few risks to making lifestyle changes. Some people do strain muscles or joints when they suddenly become active.

Sometimes the lifestyle changes are so big that they are hard to do and hard to keep up over time. If you stop doing them, you could raise your chances of getting diabetes.

What are the benefits and risks of using metformin to treat prediabetes?

Metformin:

  • Can help you lower blood sugar and prevent diabetes.
  • Is easy for some people to use. All you do is take a pill every day. But it is still important to make lifestyle changes.

Metformin has side effects. These include feeling sick to your stomach and having diarrhea, gas, or loss of appetite.

What do numbers tell us about treatments for prediabetes?

Patients who made major lifestyle changes were compared with patients who took metformin or a placebo and got information about lifestyle changes for diabetes.

People with prediabetes who get type 2 diabetes with different treatments*
Placebo plus information about lifestyle changes for diabetes Metformin plus information about lifestyle changes for diabetes Major lifestyle changes
About 29 out of 100 About 22 out of 100 About 14 out of 100

*Based on the best available evidence (evidence quality: moderate to high)

People with prediabetes who get diarrhea, gas, or loss of appetite with different treatments*
Placebo plus information about lifestyle changes for diabetes Metformin plus information about lifestyle changes for diabetes Major lifestyle changes
About 31 out of 100 About 78 out of 100 About 13 out of 100

*Based on the best available evidence (evidence quality: moderate to high)

Benefits

Take a group of 100 people who had prediabetes . Over 3 years:

  • About 29 out of 100 people who got a placebo plus lifestyle information about diabetes got diabetes. This means that about 71 out of 100 people did not.
  • About 22 out of 100 people who took metformin and got lifestyle information about diabetes got diabetes. This means that about 78 out of 100 people did not.
  • About 14 out of 100 people who made major lifestyle changes (losing weight, exercising 2½ hours a week, eating a low-calorie and low-fat diet, and attending weekly meetings) got diabetes. This means that about 86 out of 100 did not.
Risks

Take the same group of 100 people . Over 3 years:

  • About 31 out of 100 people who got a placebo plus lifestyle information about diabetes had diarrhea, gas, or loss of appetite. This means that about 69 out of 100 people did not.
  • About 78 out of 100 people who took metformin had diarrhea, gas, or loss of appetite. This means that about 22 out of 100 people did not.
  • About 13 out of 100 people who made major lifestyle changes (losing weight, exercising 2½ hours a week, eating a low-calorie and low-fat diet, and attending weekly meetings) had diarrhea, gas, or loss of appetite. This means that about 87 out of 100 did not.
Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.1 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

What do experts recommend?

The American Diabetes Association recommends starting with lifestyle changes. If these do not lower your blood sugar, your doctor might also recommend metformin.

Your doctor might also recommend metformin if you are younger than 60, have a BMI of higher than 35, and have had gestational diabetes.2

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Make major lifestyle changes Make major lifestyle changes
  • If you are overweight, you lose at least 7% of your body weight and keep it off.
  • You get moderate activity for at least 2½ hours each week.
  • You eat a diet that is low in calories and saturated fat.
  • Major lifestyle changes can lower blood sugar and help prevent diabetes.
  • Lifestyle changes can work better than metformin to prevent diabetes.
  • You may avoid digestive problems that metformin can cause.
  • Lifestyle changes can also help control or prevent high blood pressure, high cholesterol, and heart disease.
  • It may be hard and take some effort to first make and then continue the needed changes.
Take metformin Take metformin
  • You take metformin every day.
  • You try to eat more healthy foods, be active, and lose weight.
  • Metformin helps prevent diabetes.
  • Taking a daily pill may be easier for some people than making serious lifestyle changes.
  • It can be hard to remember to take medicine every day.
  • The medicine may have side effects. These include feeling sick to your stomach and having diarrhea, gas, or loss of appetite.
  • Metformin may not work as well as lifestyle changes in preventing diabetes.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about considering treatment for prediabetes

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I knew I had to do something when I found out I had prediabetes. My mom had diabetes, and I know what it's like. So I'm really going to work on it. I'm going to set goals for weight loss and exercise. And I want to see a dietitian. I'm confused about what to eat and the best way to lose weight.

Rosa, 54

I'm not sure what to do about prediabetes, but I know I have to do something. I think I'll start with metformin and also try the lifestyle changes. That way, if I'm not great at making changes, I know the pill will help me. I know that metformin is not as good as lifestyle changes. But something is better than nothing.

Richard, 60

I'm an active guy, but I know I've got some extra pounds. I've tried to lose weight before. But knowing I might get diabetes makes it really important that I lose weight. And my whole family is going to help by making some changes in how we eat. I hope that with everyone's support I can lose the weight and not have to think about using metformin.

Mikhail, 50

I tried lifestyle changes, but I didn't feel I was doing too well with them. I just couldn't find the time for exercise. I don't want to get diabetes, so I'm taking a pill every day. Maybe when things settle down, I'll try to make changes again.

Sandy, 55

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to make major lifestyle changes

Reasons to take metformin

I feel I can make the lifestyle changes.

I worry that I will not be able to make or continue lifestyle changes.

More important
Equally important
More important

I don't like to take medicine if I can help it.

If medicine can help me, I'll take it.

More important
Equally important
More important

I worry about medicine side effects.

If I can avoid diabetes by using medicine, I'll deal with any side effects.

More important
Equally important
More important

I'll start with major lifestyle changes.

I think medicine is more likely to work for me.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Making major lifestyle changes

Taking metformin

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Why is it important to prevent prediabetes from becoming diabetes?

2.

What kinds of lifestyle changes help prevent diabetes?

  • You have to get a little exercise and maybe lose some weight. No, you have to be more focused than that. Studies have shown that losing a certain amount of your weight (if you're overweight), getting at least 2½ hours of moderate activity a week, and eating a diet low in calories and saturated fat make getting diabetes less likely.
  • You set goals around weight, activity, and diet and have a plan to meet them. Yes, that's right. Studies have shown that losing a certain amount of your weight (if you're overweight), getting at least 2½ hours of moderate activity a week, and eating a diet low in calories and saturated fat make getting diabetes less likely.
  • I'm not sure It may help to go back and read "Get the Facts." Studies have shown that losing a certain amount of your weight (if you're overweight), getting at least 2½ hours of moderate activity a week, and eating a diet low in calories and saturated fat make getting diabetes less likely.
3.

Which works better, major lifestyle changes or metformin?

  • Metformin No, that's not right. Metformin does help prevent diabetes when you have prediabetes. But it doesn't work as well as major lifestyle changes.
  • Major lifestyle changes That's right. Major lifestyle changes can work better than metformin.
  • I'm not sure It may help to go back and read "Get the Facts." Major lifestyle changes work better than metformin to prevent diabetes.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Matthew I. Kim, MD - Endocrinology

References
Citations
  1. Diabetes Prevention Resource Group (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 846(6): 393–403.
  2. American Diabetes Association (2013). Standards of medical care in diabetes—2013. Diabetes Care, 36(Suppl 1): S11–S66.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prediabetes: Which Treatment Should I Use?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Make major lifestyle changes to help prevent type 2 diabetes.
  • Take the medicine metformin to help prevent type 2 diabetes.

Key points to remember

  • If you have prediabetes, your blood sugar is higher than it should be. You are more likely to get type 2 diabetes.
  • Major lifestyle changes can help prevent diabetes in people with prediabetes. These changes include losing weight, getting more exercise, and eating healthier.
  • The medicine metformin can also help prevent diabetes in people with prediabetes. But metformin doesn't work as well as major lifestyle changes.
  • Even if you take metformin, it is important to make as many healthy lifestyle changes as you can.
FAQs

What is prediabetes?

Prediabetes means that your blood sugar is higher than it should be, but not high enough to be diabetes. Most people who get type 2 diabetes have prediabetes first.

Why should you avoid diabetes?

Diabetes is a long-term illness that can have a big impact on your life. If you get it, you'll probably have to make some changes. For example, you may have to carefully watch what you eat, take medicine every day, and watch for other health problems.

Over time, diabetes can harm your eyes, nerves, and kidneys. It can damage your blood vessels. This can lead to heart disease, heart attack, and stroke. You could also have nerve damage. In your feet, this nerve damage can cause slow healing and pain when you walk. Your immune system may become weak and less able to fight infections.

How do you treat prediabetes?

The main treatment is to lower blood sugar with healthy lifestyle changes. The medicine metformin can also lower blood sugar. Research shows that people who are able to make major lifestyle changes can have more success lowering their blood sugar than people who take metformin.1 Some people may choose to take metformin and also make major lifestyle changes.

What lifestyle changes do you need to make?

Studies show that these three changes make getting diabetes less likely:1

  • Losing 7% or more of your weight, if you are overweight. If you weigh 200 pounds, losing 7% of your weight means losing 14 pounds.
  • Getting at least 2½ hours (150 minutes) of moderate activity a week. Moderate activity gets your heart pumping. It includes walking quickly, playing basketball, or dancing fast.
  • Eating a diet low in calories and saturated fat.

To prevent diabetes, you have to make major lifestyle changes. If you just change what you eat and get a little more exercise for a few months, it won't be enough.

What are the benefits and risks of using lifestyle changes to treat prediabetes?

Lifestyle changes can:

  • Help you lower blood sugar and prevent diabetes.
  • Help control or prevent high blood pressure, high cholesterol, and heart disease.
  • Help you feel better overall.

If you start slowly and follow your doctor's advice, there are few risks to making lifestyle changes. Some people do strain muscles or joints when they suddenly become active.

Sometimes the lifestyle changes are so big that they are hard to do and hard to keep up over time. If you stop doing them, you could raise your chances of getting diabetes.

What are the benefits and risks of using metformin to treat prediabetes?

Metformin:

  • Can help you lower blood sugar and prevent diabetes.
  • Is easy for some people to use. All you do is take a pill every day. But it is still important to make lifestyle changes.

Metformin has side effects. These include feeling sick to your stomach and having diarrhea, gas, or loss of appetite.

What do numbers tell us about treatments for prediabetes?

Patients who made major lifestyle changes were compared with patients who took metformin or a placebo and got information about lifestyle changes for diabetes.

People with prediabetes who get type 2 diabetes with different treatments*
Placebo plus information about lifestyle changes for diabetes Metformin plus information about lifestyle changes for diabetes Major lifestyle changes
About 29 out of 100 About 22 out of 100 About 14 out of 100

*Based on the best available evidence (evidence quality: moderate to high)

People with prediabetes who get diarrhea, gas, or loss of appetite with different treatments*
Placebo plus information about lifestyle changes for diabetes Metformin plus information about lifestyle changes for diabetes Major lifestyle changes
About 31 out of 100 About 78 out of 100 About 13 out of 100

*Based on the best available evidence (evidence quality: moderate to high)

Benefits

Take a group of 100 people who had prediabetes . Over 3 years:

  • About 29 out of 100 people who got a placebo plus lifestyle information about diabetes got diabetes. This means that about 71 out of 100 people did not.
  • About 22 out of 100 people who took metformin and got lifestyle information about diabetes got diabetes. This means that about 78 out of 100 people did not.
  • About 14 out of 100 people who made major lifestyle changes (losing weight, exercising 2½ hours a week, eating a low-calorie and low-fat diet, and attending weekly meetings) got diabetes. This means that about 86 out of 100 did not.
Risks

Take the same group of 100 people . Over 3 years:

  • About 31 out of 100 people who got a placebo plus lifestyle information about diabetes had diarrhea, gas, or loss of appetite. This means that about 69 out of 100 people did not.
  • About 78 out of 100 people who took metformin had diarrhea, gas, or loss of appetite. This means that about 22 out of 100 people did not.
  • About 13 out of 100 people who made major lifestyle changes (losing weight, exercising 2½ hours a week, eating a low-calorie and low-fat diet, and attending weekly meetings) had diarrhea, gas, or loss of appetite. This means that about 87 out of 100 did not.
Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.1 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

What do experts recommend?

The American Diabetes Association recommends starting with lifestyle changes. If these do not lower your blood sugar, your doctor might also recommend metformin.

Your doctor might also recommend metformin if you are younger than 60, have a BMI of higher than 35, and have had gestational diabetes.2

2. Compare your options

  Make major lifestyle changes Take metformin
What is usually involved?
  • If you are overweight, you lose at least 7% of your body weight and keep it off.
  • You get moderate activity for at least 2½ hours each week.
  • You eat a diet that is low in calories and saturated fat.
  • You take metformin every day.
  • You try to eat more healthy foods, be active, and lose weight.
What are the benefits?
  • Major lifestyle changes can lower blood sugar and help prevent diabetes.
  • Lifestyle changes can work better than metformin to prevent diabetes.
  • You may avoid digestive problems that metformin can cause.
  • Lifestyle changes can also help control or prevent high blood pressure, high cholesterol, and heart disease.
  • Metformin helps prevent diabetes.
  • Taking a daily pill may be easier for some people than making serious lifestyle changes.
What are the risks and side effects?
  • It may be hard and take some effort to first make and then continue the needed changes.
  • It can be hard to remember to take medicine every day.
  • The medicine may have side effects. These include feeling sick to your stomach and having diarrhea, gas, or loss of appetite.
  • Metformin may not work as well as lifestyle changes in preventing diabetes.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about considering treatment for prediabetes

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I knew I had to do something when I found out I had prediabetes. My mom had diabetes, and I know what it's like. So I'm really going to work on it. I'm going to set goals for weight loss and exercise. And I want to see a dietitian. I'm confused about what to eat and the best way to lose weight."

— Rosa, 54

"I'm not sure what to do about prediabetes, but I know I have to do something. I think I'll start with metformin and also try the lifestyle changes. That way, if I'm not great at making changes, I know the pill will help me. I know that metformin is not as good as lifestyle changes. But something is better than nothing."

— Richard, 60

"I'm an active guy, but I know I've got some extra pounds. I've tried to lose weight before. But knowing I might get diabetes makes it really important that I lose weight. And my whole family is going to help by making some changes in how we eat. I hope that with everyone's support I can lose the weight and not have to think about using metformin."

— Mikhail, 50

"I tried lifestyle changes, but I didn't feel I was doing too well with them. I just couldn't find the time for exercise. I don't want to get diabetes, so I'm taking a pill every day. Maybe when things settle down, I'll try to make changes again."

— Sandy, 55

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to make major lifestyle changes

Reasons to take metformin

I feel I can make the lifestyle changes.

I worry that I will not be able to make or continue lifestyle changes.

             
More important
Equally important
More important

I don't like to take medicine if I can help it.

If medicine can help me, I'll take it.

             
More important
Equally important
More important

I worry about medicine side effects.

If I can avoid diabetes by using medicine, I'll deal with any side effects.

             
More important
Equally important
More important

I'll start with major lifestyle changes.

I think medicine is more likely to work for me.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Making major lifestyle changes

Taking metformin

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Why is it important to prevent prediabetes from becoming diabetes?

  • Diabetes is a lifelong disease. If you get it, you'll probably have to watch what you eat, take medicine, and watch for other health problems.
  • Diabetes can harm your eyes, nerves, and kidneys. It can lead to heart disease and stroke.
  • I'm not sure
Yes, both answers are correct. Diabetes will have a big impact on your life and may lead to many other problems.

2. What kinds of lifestyle changes help prevent diabetes?

  • You have to get a little exercise and maybe lose some weight.
  • You set goals around weight, activity, and diet and have a plan to meet them.
  • I'm not sure
Yes, that's right. Studies have shown that losing a certain amount of your weight (if you're overweight), getting at least 2½ hours of moderate activity a week, and eating a diet low in calories and saturated fat make getting diabetes less likely.

3. Which works better, major lifestyle changes or metformin?

  • Metformin
  • Major lifestyle changes
  • I'm not sure
That's right. Major lifestyle changes can work better than metformin.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Matthew I. Kim, MD - Endocrinology

References
Citations
  1. Diabetes Prevention Resource Group (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 846(6): 393–403.
  2. American Diabetes Association (2013). Standards of medical care in diabetes—2013. Diabetes Care, 36(Suppl 1): S11–S66.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Revised: August 22, 2013

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