5MinuteConsult Journal Club
Preventing Prediabetes from Becoming Type 2 Diabetes
Am J Prev Med 2022; 62(4): 614-25
This is a systematic review of SR 54 studies on treatments to prevent prediabetes from evolving into type 2 diabetes. Those treatments found to be most effective include:
--Lifestyle modification (risk difference (RD)) = 0.18, NNT = 6
--GLP-1 agonists (RD = 0.47), NNT = 2
--Magnesium supplements (RD=0.44) NNT = 2
--Chinese medicine (RD=0.31), NNT=3
Other medications found to have some ability to reverse prediabetes included insulin sensitizers (metformin, rosiglitazone, and pioglitazone), acarbose and fenofibrate.
For those with prediabetes, aggressive lifestyle modification counseling and use of GLP-1 agonists and magnesium supplementation along with an insulin sensitizer like metformin.
This systematic review and meta-analysis contains vast information; what it does not detail is the specifics of “Chinese medicine.” Thus, I would exclude that from my practice, but most everything else should be on the table for primary care.
There is data that “only” 10% of those with prediabetes will evolve to Type 2 diabetes and describe screening for prediabetes is a form of over-diagnosis. But prediabetes correlates with many other conditions, including Non-alcoholic Fatty Liver Disease (NAFLD), hypertension, obesity, some cancers, and premature cardiovascular disease. If reversing prediabetes slows or prevents any of these conditions, then we should all be providing this care.
My approach is patient-centered counseling to identify small changes they can make (and not ‘dieting’). Start with metformin and a magnesium supplement of at least 500 mgs (Br J Nutr . 2022 Jan 20;1-10. doi: 10.1017/S0007114521005201). Repeat labs in 3 months and if A1c is not coming down, add a GLP-1 agonist (I have had good success overcoming insurance denials by explaining up front their comorbidities, including HTN, NAFLD, hyperlipidemia, etc.)
While you may not prevent Type 2 diabetes from occurring, this approach will lower many health risks and help the patient lose weight and feel better. That is win-win-win.
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Contributed by Frank J. Domino, August 3, 2022