Metformin in prediabetes

Metformin in Prediabetes

NICE suggest that a clinician should use clinical judgement on whether (and when) to offer metformin to support lifestyle change for people whose HbA1c or fasting plasma glucose blood test results have deteriorated if:

• this has happened despite their participation in intensive lifestyle-change programmes or
• they are unable to participate in an intensive lifestyle-change programme, particularly if they have a BMI greater than 35

Check renal function before starting treatment, and then twice yearly (more often if they are older or if deterioration is suspected).

Dose:

• start with a low dose (for example, 500 mg once daily) and then increase gradually as tolerated, to 1500–2000 mg daily. If the person is intolerant of standard metformin consider using modified-release metformin

Duration:

• prescribe metformin for 6-12 months initially. Monitor the person's fasting plasma glucose or HbA1c levels at 3-month intervals and stop the drug if no effect is seen (1).

Reference:

• NICE (July 2012). Type 2 diabetes: prevention in people at high risk (Updated September 2017)
• Prediabetes (Borderline diabetes). Diabetes UK (Accessed 27/9/2017)