Metformin Should Not Be Used to Treat Prediabetes

Based on the results of the Diabetes Prevention Program Outcomes Study (DPPOS), in which metformin significantly decreased the development of diabetes in individuals with baseline fasting plasma glucose (FPG) concentrations of 110–125 vs. 100–109 mg/dL (6.1–6.9 vs. 5.6–6.0 mmol/L) and A1C levels 6.0–6.4% (42–46 mmol/mol) vs. <6.0% and in women with a history of gestational diabetes mellitus, it has been suggested that metformin should be used to treat people with prediabetes. Since the association between prediabetes and cardiovascular disease is due to the associated nonglycemic risk factors in people with prediabetes, not to the slightly increased glycemia, the only reason to treat with metformin is to delay or prevent the development of diabetes. There are three reasons not to do so. First, approximately two-thirds of people with prediabetes do not develop diabetes, even after many years. Second, approximately one-third of people with prediabetes return to normal glucose regulation. Third, people who meet the glycemic criteria for prediabetes are not at risk for the microvascular complications of diabetes and thus metformin treatment will not affect this important outcome. Why put people who are not at risk for the microvascular complications of diabetes on a drug (possibly for the rest of their lives) that has no immediate advantage except to lower subdiabetes glycemia to even lower levels? Rather, individuals at the highest risk for developing diabetes—i.e., those with FPG concentrations of 110–125 mg/dL (6.1–6.9 mmol/L) or A1C levels of 6.0–6.4% (42–46 mmol/mol) or women with a history of gestational diabetes mellitus—should be followed closely and metformin immediately introduced only when they are diagnosed with diabetes.

Metformin Should Not Be Used to Treat Prediabetes — Diabetes Care 2020 Sep; 43(9): 1983-1987. https://doi.org/10.2337/dc19-2221

Diabulimia

I live with “the world’s most dangerous” eating disorder

I have been struggling with diabulimia on and off since my diagnosis of type 1 diabetes in 2011, at age 30. I had just started a PhD and spent the first semester walking around campus with all the classic symptoms of type 1 diabetes: famished, dehydrated, constantly needing to urinate, and experiencing rapid weight loss. After my diabetes diagnosis, when I started injecting insulin, I gained the weight back—and then some. It didn’t take long to figure out that omitting insulin was not only an effective weight loss tool, compared with vomiting, it was a much less violent way to purge. Having a history of bulimia nervosa, I thought I had found the holy grail. I could eat what I wanted, not use insulin, and not gain weight.

And I thought Orthorexia Nervosa was bad.

Pass (on) the Chips

Eating Ultraprocessed Foods Tied to Diabetes Risk

Higher intake of ultraprocessed foods (for example, packaged snack foods) is associated with increased risk for type 2 diabetes, according to a prospective study in JAMA Internal Medicine.

Over 100,000 French adults completed a series of 24-hour dietary recall questionnaires over a 2-year period. During a median follow-up of 6 years, roughly 820 participants were diagnosed with type 2 diabetes.

After adjustment for body-mass index, physical activity, and other confounders, participants who ate more ultraprocessed foods were at higher risk for diabetes. In particular, the risk increased by 13% with each 10% increase in the proportion of diet comprising ultraprocessed foods.

The authors note that in previous studies, ultraprocessed foods have been linked to increased risks for cancer, cardiovascular disease, and mortality.

JAMA Internal Medicine article (Free abstract)

Background: Physician’s First Watch coverage of ultraprocessed foods & mortality (Free)

NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society. Copyright © 2019 Massachusetts Medical Society. All rights reserved.

Junk food = bad.

Fake Burgers = also bad.

Got DM1? Don’t do Pot

Abstract

OBJECTIVE We examined the frequency of diabetic ketoacidosis (DKA) in cannabis users compared with nonusers in the T1D Exchange clinic registry (T1DX).

RESEARCH DESIGN AND METHODS The association between cannabis use by total substance score for cannabis (TSC) and DKA in the past 12 months was examined using a logistic regression model adjusted for potential confounders among adults in the T1DX.

RESULTS Of 932 adults with type 1 diabetes, 61 had a TSC >4, which classified them as moderate cannabis users. Adjusting for sex, age at study visit, and HbA1c, cannabis use was associated with a twofold increase in risk for DKA among adults with type 1 diabetes (odds ratio 2.5 [95% CI 1.0–5.9]).

CONCLUSIONS Cannabis use was associated with an increased risk for DKA among adults in the T1DX. Providers should inform their patients of the potential risk of DKA with cannabis use.

© 2019 by the American Diabetes Association.

Cannabis Use Is Associated With Increased Risk for Diabetic Ketoacidosis in Adults With Type 1 Diabetes: Findings From the T1D Exchange Clinic Registry

Obesity Linked to Nearly 6-fold Increased Risk of Developing type 2 Diabetes

The researchers found that having an unfavorable lifestyle and obesity are associated with a greater risk of developing T2D regardless of their genetic risk. Obesity (defined as a body mass index of 30 kg/m2 or higher) increased T2D-risk by 5.8-fold compared to individuals with normal weight. The independent effects of high (vs. low) genetic risk and unfavourable (vs. favourable) lifestyle were relatively modest by comparison, with the highest genetic risk group having a 2-fold increased risk of developing T2D compared with the lowest group; and unfavourable lifestyle was associated with a 20% increased risk of developing T2D compared with favourable lifestyle.

Link to source article.

 

A Plant-based Diet may Lower type 2 Diabetes Risk

Findings  In this systematic review and meta-analysis of prospective observational studies assessing the association between plant-based dietary patterns and risk of type 2 diabetes among adults, higher adherence to plant-based dietary patterns was associated with a lower risk of type 2 diabetes; this association was strengthened when healthy plant-based foods, such as fruits, vegetables, whole grains, legumes, and nuts, were included in the pattern. Findings were broadly consistent in several prespecified subgroups and in sensitivity analyses.

Take this link to the JAMA Internal Medicine article.

Take this link to the Harvard T.H. Chan press release.

 

Natural Food Interaction (NFI) Diet and DM2

We spoke about the results, which will be published and constitute an unprecedented 97.2 percent type 2 diabetes remission rate. Meaning that based on current data, anyone suffering from type 2 diabetes has a near 100 percent probability of entering full clinical remission within 20 weeks if they follow the NFI diet.

https://nutritionstudies.org/my-type-2-diabetic-patients-transformed-their-health-through-diet/?utm_source=Master+List&utm_campaign=jun19&utm_medium=email&utm_term=newsletter+links

Diabetes runs in my family.  My father had diabetes and my youngest brother also has the disease.  I do a lot of reading and research to better understand what I personally need to do to never develop diabetes.  The NFI diet sounds amazing.  This is just another powerful piece of evidence that supports adopting a mostly plant based diet.

If you’re as excited about this news as I am please share these articles and links.  Your diabetic family and friends will thank you.

And if you’re wondering my last fasting blood sugar was <100mg/dl and my A1C last measured in 2015 was 5.8%.

Long-term Effects of Metformin on Diabetes Prevention: Identification of Subgroups That Benefited Most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study

CONCLUSIONS – Metformin reduces the development of diabetes over 15 years. The subsets that benefitted the most include subjects with higher baseline fasting glucose or HbA1c and women with a history of GDM.

You can access the abstract and full study online at this link to the Diabetes Journal.

The commentary article at this link is also an interesting read.

More Evidence for a Prevention-Related Indication for Metformin: Let the Arguments Resume!