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Prediabetes Treatment Guidelines

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1) Lifestyle Modifications

2) Routine testing: Annual A1c & lipid panel

3) Metformin: Best data comes from Diabetes Prevention Program study in NEJM: https://www.nejm.org/doi/full/10.1056/nejmoa012512. Randomized patients with prediabetes to usual care, metformin, or intensive lifestyle changes with outcome looking at development of diabetes. Found that intensive lifestyle > metformin > usual care. The reason we treat diabetes is to prevent complications, and there is ZERO data that early initiation of metformin in pre-diabetes averts mortality or prevents/delays microvascular or macrovascular complications. Cochrane review for metformin in Prediabetes: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008558.pub2/full