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

Metabolic Syndrome and Stroke Risk

 

To evaluate the association between ischemic stroke and metabolic syndrome, DeBoer and Gurka reviewed more than 13,000 participants in prior studies and their stroke outcomes. Among that group, there were 709 ischemic strokes over a mean period of 18.6 years assessed in the studies. (Ischemic strokes are caused when blood flow to the brain is obstructed by blood clots or clogged arteries. Hemorrhagic strokes, on the other hand, are caused when blood vessels rupture.)

DeBoer developed the scoring tool, an online calculator to assess the severity of metabolic syndrome, with Matthew J. Gurka, PhD, of the Department of Health Outcomes and Biomedical Informatics at the University of Florida, Gainesville. The tool is available for free at https://metscalc.org/.

Journal Reference: Mark D. DeBoer, Stephanie L. Filipp, Mario Sims, Solomon K. Musani, Matthew J. Gurka. Risk of Ischemic Stroke Increases Over the Spectrum of Metabolic Syndrome Severity. Stroke, 2020; 51 (8): 2548 DOI: 10.1161/STROKEAHA.120.028944

This online calculator can predict your stroke risk

Presented with the following caveat:

I tried the calculator but I’m not quite sure how useful it will be in clinical settings.  As far as insurance underwriting is concerned I probably won’t use it.

Be Nice to Your Liver – Eat Yogurt

Yogurt improves insulin resistance and liver fat in obese women with nonalcoholic fatty liver disease and metabolic syndrome: a randomized controlled trial

Conclusions

Yogurt was better than milk at ameliorating IR and liver fat in obese Chinese women with NAFLD and MetS, possibly by improving lipid metabolism, reducing inflammation, oxidative stress, and LPS, and changing the gut microbiota composition. This trial was registered at www.chictr.org.cn as ChiCTR-IPR-15006801.

Resistance Training Tied to Lower Risk for Metabolic Syndrome — Physician’s First Watch

After adjustment for potential confounders like aerobic exercise levels, doing any resistance exercise was associated with lower risk for metabolic syndrome, compared with no resistance training (hazard ratio, 0.83). People who met guidelines for recommended amounts of both resistance exercise (≥2 days/wk) and aerobic exercise (≥500 metabolic equivalent min/wk) had a 25% lower risk for metabolic syndrome than those who didn’t hit the recommended amounts.

Source: Resistance Training Tied to Lower Risk for Metabolic Syndrome — Physician’s First Watch

Link to the original article below.

Source: Association of Resistance Exercise, Independent of and Combined With Aerobic Exercise, With the Incidence of Metabolic Syndrome – Mayo Clinic Proceedings

Expanding waistlines and metabolic syndrome: Researchers warn of new ‘silent killer’: Caused by overweight and obesity, metabolic syndrome affects 40 percent of Americans age 40 and older — ScienceDaily

For optimal health, the waist should measure less than 40 inches for men and 35 inches for women.

Source: Expanding waistlines and metabolic syndrome: Researchers warn of new ‘silent killer’: Caused by overweight and obesity, metabolic syndrome affects 40 percent of Americans age 40 and older — ScienceDaily