Hormonal
Long-term metformin (850 mg twice daily) and intensive lifestyle interventions do not reduce major cardiovascular events in individuals with prediabetes, despite significantly delaying or preventing the onset of type 2 diabetes.
Taking metformin or following a strict lifestyle program to prevent diabetes does not guarantee protection against heart attacks or strokes, even if you successfully avoid developing diabetes. In this long-term study, these interventions prevented diabetes but did not lower cardiovascular event rates compared to placebo, likely because other risk factors (blood pressure, cholesterol) were managed by standard care. Focus on comprehensive risk management, not just glucose control.
Neither metformin nor lifestyle intervention reduced the primary outcome: metformin versus placebo hazard ratio 1.03 (95% CI, 0.78–1.37; P = 0.81) and lifestyle versus placebo hazard ratio 1.14 (95% CI, 0.87–1.50; P = 0.34).
Why this rating
Large randomized controlled trial (n=3234) with 21-year median follow-up and adjudicated outcomes.
Source
Effects of Long-term Metformin and Lifestyle Interventions on Cardiovascular Events in the Diabetes Prevention Program and Its Outcome Study
Ronald Goldberg et al. · Circulation · 2022
DOI 10.1161/circulationaha.121.056756
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