Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
  • LinkedIn
  • Instagram
LetterLetter

Addressing metformin

David Dannenbaum
Canadian Family Physician July 2009; 55 (7) 690;
David Dannenbaum
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

I read with interest the Lilly and Godwin article “Treating prediabetes with metformin. Systematic review and meta-analysis”1 and had several concerns. Lilly and Godwin base their conclusion on treatment of prediabetes (impaired glucose tolerance [IGT] or impaired fasting glucose [IFG]) with metformin on studies of patients with either IGT alone or IGT and IFG. I do not think the conclusions from their meta-analysis can be made for patients with isolated IFG. I was also concerned with their conclusion that treatment with metformin is beneficial for patients with IGT. In the case of prehypertension, for example, treating prehypertension with an antihypertensive medication would likely lower blood pressure with a very low number needed to treat; however, as there are no outcome studies that show treating prehypertension with a blood pressure–lowering agent will prevent complications, we treat prehypertension with lifestyle modification alone. The same is true for prediabetes. Although Lilly and Godwin raise the important issue of using glucose-lowering agents to treat prediabetes in the limitations discussion of their study, it is a serious enough limitation that it should have influenced the conclusion of their meta-analysis. Just because metformin lowers blood sugar (and therefore prevents diabetes) does not mean we should be treating all patients with prediabetes with metformin.

I do agree that prediabetes is a serious medical condition, warning patients that their risk of subsequent diabetes is very high. This is a golden opportunity to maintain close follow-ups with patients to ensure they are able to slowly make the lifelong lifestyle changes required to prevent diabetes. Just giving metformin to all prediabetes patients will not address this lifelong condition. Any amount of exercise and any amount of weight loss will do the same or more as metformin. Several studies have shown a 60% reduction of diabetes with lifestyle changes, twice as effective as metformin.2,3

There are patients with prediabetes who might require metformin, but these cases should be the exception not the rule.

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    LillyMGodwinMTreating prediabetes with metformin. Systematic review and meta-analysisCan Fam Physician2009553639
    OpenUrlAbstract/FREE Full Text
  2. ↵
    TuomilehtoJLindströmJErikssonJGValleTTHämäläinenHIlanne-ParikkaPPrevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose intoleranceN Engl J Med200134418134350
    OpenUrlCrossRefPubMed
  3. ↵
    KnowlerWCBarrett-ConnorEFowlerSEHammanRFLachinJMWalkerEAReduction in the incidence of type 2 diabetes with lifestyle intervention or metforminN Engl J Med20023466393403
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Family Physician: 55 (7)
Canadian Family Physician
Vol. 55, Issue 7
1 Jul 2009
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Addressing metformin
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Addressing metformin
David Dannenbaum
Canadian Family Physician Jul 2009, 55 (7) 690;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Addressing metformin
David Dannenbaum
Canadian Family Physician Jul 2009, 55 (7) 690;
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Response
  • Concern is not based on evidence
  • Rural maternity care
Show more Letter

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • LinkedIn
  • Instagram
  • RSS Feeds

Copyright © 2025 by The College of Family Physicians of Canada

Powered by HighWire