Response

Dr Dhar, thank you for the review of the pathophysiology of prediabetes, diabetes, and the metabolic syndrome. I have been using metformin in my patients with prediabetes for a few years now. It does remain true, of course, that exercise and diet are better solutions, but compliance is a problem with those modalities.

Using metformin to treat prediabetes1 has not yet been recommended in the various diabetes guidelines published in many different countries. Perhaps this is owing to the question of whether the effects we see are preventive effects or simply treatment effects as well as the lack of data showing a benefit to cardiovascular morbidity and mortality by using metformin early on (at the prediabetes stage). That study in particular needs to be done.

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