Metformin is blood-sugar-lowering medication used to treat Type 2 diabetes and prediabetes. With Type 2 diabetes, your body does not metabolize blood sugar, or glucose, normally due to cellular resistance to the hormone insulin. Diet and exercise, metformin or both help correct this metabolic abnormality, which causes high blood sugar levels. Diet and exercise are commonly the first line of treatment when you are newly diagnosed Type 2 diabetes or prediabetes.
Two Approaches, One Goal
Reduction of your body's insulin resistance is a primary treatment goal with Type 2 diabetes or prediabetes. Reduction in insulin resistance translates into lower blood sugar levels and reduced risk of long-term diabetes complications. Overweight or obesity and physical inactivity are important contributing factors to the development of insulin resistance and prediabetes or Type 2 diabetes. A low-fat, reduced-calorie diet that leads to a 5 to 7 percent reduction in body weight coupled with moderate physical activity improves your insulin sensitivity, leading to reduced blood sugar levels. The drug metformin has similar effects, reducing your insulin resistance and blood sugar levels.
Prediabetes Treatment
With prediabetes, or borderline diabetes, your body resists insulin to a lesser degree than with full-blown Type 2 diabetes. Having prediabetes significantly increases your risk of developing Type 2 diabetes. Delaying or preventing the development of Type 2 diabetes is the primary objective of treatment for this condition. In a hallmark study published in the "New England Journal of Medicine" in February 2002, Dr. William Knowler and colleagues state that successful lifestyle interventions are more effective than metformin at preventing the development of Type 2 diabetes among people with prediabetes. The authors note a 58 percent reduction in progression to Type 2 diabetes among study participants who lost 5 to 7 percent of their body weight and participated in moderate exercise for at least 150 minutes weekly. The incidence of progression to Type 2 diabetes was reduced by 31 percent among study participants who took metformin.
ADA Recommendations
The American Diabetes Association's 2011 "Standards of Medical Care in Diabetes" recommends that all people with prediabetes begin a diet and exercise program. Treatment with metformin may be considered along with diet and exercise if you have multiple risk factors for Type 2 diabetes, including overweight or obesity, high blood pressure and abnormal blood fat levels.
Type 2 Diabetes Treatment
Whereas a blood sugar test determines your glucose level at a given point in time, your doctor monitors long-term blood sugar control by measuring your glycated hemoglobin, also known as A1c. Your risk of diabetes complications increases with your A1c level. In a January 2009 article published in the journal "Diabetes Care," Dr. David Nathan and colleagues report that diet and exercise, and metformin can each lower your A1c level by 1 to 2 percent. Depending on how high your A1c level is at diagnosis, your doctor may advise a trial of diet and exercise alone to determine whether this strategy sufficiently lowers your A1c. If your initial A1c level is significantly elevated, your doctor may prescribe metformin along with diet and exercise for initial treatment of Type 2 diabetes.
References
- National Institute of Diabetes and Digestive and Kidney Diseases: Insulin Resistance and Prediabetes
- PubMed Health: Metformin
- "New England Journal of Medicine"; Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin; William C. Knowler, M.D., Dr.P.H., et al.; February 2002
- "Diabetes Care"; Executive Summary: Standards of Medical Care in Diabetes---2011; American Diabetes Association; January 2011
- "Diabetes Care"; Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy; David M. Nathan, M.D., et al.; January 2009
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