Hormonal
Metformin reduces the risk of progression from prediabetes to type 2 diabetes by 31% and is recommended for specific high-risk subgroups (age 25-59, BMI ≥35, FPG ≥6.1 mmol/L, or history of gestational diabetes).
If lifestyle changes alone are not enough, your doctor may prescribe metformin. It is typically started at a low dose (500 mg) and increased to 1,500 mg daily to minimize stomach issues. Use the extended-release version if possible. Monitor your blood sugar every 6 months. This is particularly recommended if you are younger, have a higher BMI, or have a history of gestational diabetes.
In the DPP, randomization to metformin was associated with a –31% reduction on the risk of conversion of IGT to T2D, compared with a –58% reduction for the intensive lifestyle intervention, both compared with standard lifestyle advice.
Why this rating
Supported by large RCTs (DPP, CDPP) and meta-analyses.
Source
Intervening Early in the Cardiovascular-Kidney-Metabolic Syndrome: Expert Recommendations from the United Arab Emirates on the Management of Prediabetes
Salah Abusnana et al. · Vascular Health and Risk Management · 2026
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