Medication
- Being overweight
- Being 45 years or older
- Having a parent, brother, or sister with type 2 diabetes
- Being physically active less than 3 times a week
- Ever having gestational diabetes (diabetes during pregnancy) or giving birth to a baby who weighed more than 9 pounds
Self-care
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Nutrition
What Are the Best Drugs to Treat Diabetes?
- Insulin (long- and rapid-acting)
- Metformin (biguanide class)
- Glipizide (sulfonylurea class)
- Glimepiride (sulfonylurea class)
- Invokana (sodium glucose cotransporter 2 inhibitor class)
- Jardiance (SGLT2 class)
- Januvia (dipeptidyl peptidase 4 inhibitor)
- Pioglitazone (thiazolidinediones)
- Victoza (glucagon-like peptide 1 agonist)
See more
Children with prediabetes should undertake the lifestyle changes recommended for adults with type 2 diabetes, including: Medication generally isn't recommended for children with prediabetes unless lifestyle changes aren't improving blood sugar levels. If medication is needed, metformin (Glumetza, others) is usually the recommended drug.
What type medication should I consider for prediabetes?
What are the names of some diabetic medications?
What are the best drugs to treat diabetes?
Should antidiabetics be prescribed in prediabetes?
Which medication is the initial choice for treatment of prediabetes?
The oral biguanide metformin (Glucophage, and others) is generally the drug of choice for initial treatment of type 2 diabetes. It has also been used to prevent or at least delay the onset of diabetes in patients considered to be at high risk for the disease.
What is the initial treatment for diabetes?
Metformin (Fortamet, Glumetza, others) is generally the first medication prescribed for type 2 diabetes. It works primarily by lowering glucose production in the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively.
Which medication is the initial drug of choice for most patients with type 2 diabetes?
Metformin should be the first-line drug for managing type 2 diabetes. Insulin and sulfonylureas should be second line, and glitazones should be reserved for third line.
Is medication recommended for prediabetes?
While lifestyle changes can work wonders, some people with prediabetes also need medication. Your doctor may prescribe metformin if you have certain risk factors, such as low levels of HDL ("good") cholesterol, high triglycerides (a type of blood fat), a parent or sibling with diabetes, or are overweight.
What is metformin used for?
Metformin: a medicine to treat type 2 diabetes - NHS.
Which medicine is best for diabetes?
What Are the Best Drugs to Treat Diabetes?Insulin (long- and rapid-acting) ... Metformin (biguanide class) ... Glipizide (sulfonylurea class) ... Glimepiride (sulfonylurea class) ... Invokana (sodium glucose cotransporter 2 inhibitor class) ... Jardiance (SGLT2 class) ... Januvia (dipeptidyl peptidase 4 inhibitor)More items...•
Why is metformin used as first-line treatment?
The UKPDS results, including glycemic-lowering efficacy, the weight benefits, the low risk for hypoglycemia, and the reduction in macrovascular complications, led to metformin becoming the preferred first-line therapy for treatment of type 2 diabetes.
Is metformin The best treatment for type 2 diabetes?
MONDAY, Jan. 2, 2017 (HealthDay News) -- Newly updated guidelines reaffirm that metformin is the first-line drug for people with type 2 diabetes, and that several other medications -- including newer ones -- can be added if needed.
Which medication is the drug of choice for initial treatment of a newly diagnosed patient with type 2 diabetes and no contraindications?
Metformin — In the absence of specific contraindications, we suggest metformin as initial therapy for patients with newly diagnosed type 2 diabetes who are asymptomatic. We begin with 500 mg once daily with the evening meal and, if tolerated, add a second 500 mg dose with breakfast.
Is metformin used to treat prediabetes?
The ADA recommends that, in addition to lifestyle counseling, metformin be considered in selected patients with prediabetes.
Should metformin be used for prediabetes?
Diabetes Care. 2020 Sep;43(9):1983-1987. doi: 10.2337/dc19-2221.
How does metformin work for prediabetes?
Metformin is an oral medication that helps to control blood sugar levels. It does this by helping your body to make less glucose (sugar) and to use your naturally produced insulin more effectively. It is available in immediate release (IR) and extended release (ER) versions.
What is the rationale behind prediabetes?
The rationale behind treatment of prediabetes includes, prevention of development of diabetes, prevention of consequences of diabetes and prevention of the consequences of prediabetes itself. Several research studies have shown success of interventions designed for treatment of prediabetes with sustained reduction in incidence of diabetes[20,54,80-82]. The CDQDPS study, with lifestyle intervention and 20 year follow-up showed nearly 50% relative risk reduction in incidence of severe retinopathy, but there was no difference between the intervention and control groups in the risk of developing other microvascular complications, such as neuropathy and nephropathy[83]. The evidence regarding effects of interventions on macrovascular complications is inconsistent. The Malmo Preventive Project with a 12 year follow-up, showed reduce mortality in subjects with IGT after a long-term lifestyle intervention program, with emphasis on dietary counseling and physical activity, but this was not a randomized trial[84]. The Collective evidence of all randomized control trails among prediabetic subjects with lifestyle and drug based interventions in a recent meta-analysis showed that these interventions resulted in reduction in stroke risk but did not result in any risk reduction for all-cause mortality, cardiovascular death or myocardial infarction over a mean follow-up period of 3.8 years[80]. While, the current evidence suggests efficacy of several treatment modalities regarding prevention of progression to diabetes, the long term benefits on microvascular or macrovascular complications remains debatable. There is no evidence to suggest that early intervention is better than late intervention and long term studies looking at cost vsbenefit and long terms of outcomes related to the point at which glycemic intervention should begin are lacking. Majority of published literature and guidelines support that lifestyle interventions focusing on dietary modification and increased physical activity should be the foundation of therapy for diabetes prevention in patients with prediabetes. Although, lifestyle interventions are safe and have proven efficacy in prevention of diabetes, these programs are not reimbursed by most health care insurance plans. There is increasing evidence to prove the efficacy of pharmacotherapy and support its use in adults with prediabetes. Due to the favorable long term safety profile and observed positive outcomes with metformin, organizations such as ADA have recommended the use of metformin in certain high risk individuals[85] but the end point of pharmacotherapy is yet to be defined. The concept of prediabetes or its treatment has not been systematically studied in children with prediabetes. Long term effect of common medications used for prediabetes on growth and pubertal development in children have not been studied. Moreover in children, due to puberty related insulin resistance, incidence of diabetes may be over all inflated. There is lack of evidence with regards to long term efficacy as well as safety for use of pharmacotherapy in children with prediabetes.
What are the antidiabetic drugs?
Several groups of antidiabetic drugs such as Biguanides, Thiazolidinediones, α-Glucosidase Inhibitors, GLP-1 analogies and non-antidiabetic drugs and therapies such as anti-obesity drugs, and bariatric surgery have been studied in context of prediabetes.
What is the definition of prediabetes?
The World Health Organization (WHO) has defined prediabetes as a state of intermediate hyperglycemia using two specific parameters, impaired fasting glucose (IFG) defined as fasting plasma glucose (FPG) of 6.1-6.9 mmol/L (110 to 125 mg/dL) and impaired glucose tolerance (IGT) defined as 2 h plasma glucose of 7.8-11.0 mmol/L (140-200 mg/dL) after ingestion of 75 g of oral glucose load or a combination of the two based on a 2 h oral glucose tolerance test (OGTT)[1]. The American Diabetes Association (ADA), on the other hand has the same cut-off value for IGT (140-200 mg/dL) but has a lower cut-off value for IFG (100-125 mg/dL) and has additional hemoglobin A1c (HbA1c) based criteria of a level of 5.7% to 6.4% for the definition of prediabetes[2]. Several studies have shown poor correlation between HbA1c and IFG and IGT[3-5]. The usefulness of diagnosis of diabetes or prediabetes on basis of IFG and IGT have been challenged due to inability of these blood glucose cut points to capture pathology related to diabetes and probability of developing diabetes in future[6]. These cut-offs further loose their credibility due to poor reproducibility of these tests in adults and children[7,8]. Although, HbA1c is believed to represent an average blood sugar level and should ideally represent hyperglycemia more accurately, this may not be entirely true. HbA1c is substantially determined by genetic factors independent of blood glucose levels and may be an imprecise tool to measure average blood sugar[9,10]. While there are valid concerns about diagnostic criteria of prediabetes, prediabetes remains to have a lower reproducibility (approximately 50%) than diabetes (approximately 70%). Based on the available evidence, it appears that prediabetes defined by various alternative criterions consists of an overlapping group of individuals with one or more abnormalities in their glucose excursions. It is possible that presence of IFG and IGT identifies subjects with different pathological abnormalities in their glucose metabolism and presence of both of these signifies more advanced impairment in overall glucose homeostasis.
What percentage of prediabetes have retinopathy?
Nearly 8 percent of participants with prediabetes in the DPP study were found to have evidence of diabetic retinopathy[44]. While prediabetes has been associated with an increased risk of diabetic retinopathy in some studies, these findings vary depending on the method used for detection[24,45-49].
What are the effects of GLP-1?
The most common side effects with these drugs are nausea and vomiting and they remain injectable preparations[72-74].
Is there a systematic evaluation of health outcomes related to prediabetes in children?
There are no reports of systematic evaluation of health outcomes related to prediabetes in children. The effects of pharmacotherapy of prediabetes on growth and pubertal development in children remains unknown. Secondary intervention with pharmacotherapy with metformin is advocated for high-risk individuals but criteria for such consideration ...
Is prediabetes a state of high risk?
While, the diagnostic criteria of prediabetes are not uniform across various international professional organizations, it remains a state of high risk for developing diabetes with yearly conversion rate of 5%-10%. Observational evidence suggests as association between prediabetes and complications of diabetes such early nephropathy, small fiber neuropathy, early retinopathy and risk of macrovascular disease. Several studies have shown efficacy of lifestyle interventions with regards to diabetes prevention with a relative risk reduction of 40%-70% in adults with prediabetes. While there is increasing evidence to prove the efficacy of pharmacotherapy in prevention of diabetes in adults with prediabetes, pharmaceutical treatment options other than metformin are associated with adverse effects that limit their use for prediabetes. There are no reports of systematic evaluation of health outcomes related to prediabetes in children. The effects of pharmacotherapy of prediabetes on growth and pubertal development in children remains unknown. Secondary intervention with pharmacotherapy with metformin is advocated for high-risk individuals but criteria for such consideration benefit of early intervention, long term cost effectiveness of such interventions and the end point of therapy remain unclear. Pharmacotherapy must be used with caution in children with prediabetes. Prediabetes is a condition defined as having blood glucose levels above normal but below the defined threshold of diabetes. It is considered to be an at risk state, with high chances of developing diabetes. While, prediabetes is commonly an asymptomatic condition, there is always presence of prediabetes before the onset of diabetes. The elevation of blood sugar is a continuum and hence prediabetes can not be considered an entirely benign condition. This aim of this review is to describe the challenges associated with diagnosis of prediabetes, the possible adverse medical outcomes associated with prediabetes and the treatment options and rationale for their use in context of prediabetes.
What is the most common medication for prediabetes?
Most Common Medications for Prediabetes. Classes of medications for patients with prediabetes include biguanides, thiazolidinediones, and α-Glucosidase Inhibitors, according to a review article in World Journal of Diabetes. The best-known biguanide may be metformin, with Glucophage being the most common brand name.
What is prediabetes medication?
Prediabetes medication (s) to control blood sugar and/or increase insulin sensitivity. Screening and any necessary treatment for high blood pressure and high cholesterol. Lifestyle Modification: The American Diabetes Association (ADA) recommends that people with prediabetes take part in a lifestyle intervention program.
What are the risks of prediabetes?
A prediabetes treatment plan may include regular blood pressure measurements and blood tests for cholesterol levels. Prescription medications may be necessary to control your numbers.
How does prediabetes affect diabetes?
Prediabetes treatments can lower your risk for diabetes and complications of diabetes. Lifestyle modifications, such as losing extra weight and increasing physical activity, are the most effective approaches for most people. Certain medications can also help delay the onset of type 2 diabetes or prevent it altogether.
What are some ways to lower blood sugar?
Eating well and getting enough sleep are examples of other healthy choices that can lower blood sugar. Lark DPP provides coaching, through your smartphone, on all of these areas. Prediabetes Medication: Medications can help lower blood sugar and reduce type 2 diabetes risk.
How many people with prediabetes develop diabetes?
About 5 to 10% of people with prediabetes develop diabetes each year, and 90% of people with prediabetes will develop diabetes within the next 20 years, according to a review article in Diabetes Care. Prediabetes treatments can lower your risk for diabetes and complications of diabetes. Lifestyle modifications, ...
What is the best way to lower blood sugar for prediabetes?
This can be a Centers for Disease Control and Prevention (CDC)-Recognized Diabetes Prevention Program (DPP) with a focus on weight loss and physical activity. Eating well and getting enough sleepare examples of other healthy choices that can lower blood sugar. Lark DPPprovides coaching, through your smartphone, on all of these areas.
What are the lipid goals for prediabetes?
The experts recommend statins to achieve lipid treatment goals of 100 mg/dL for LDL; 130 mg/dL for non-HDL; and 90 mg/dL for apolipoprotein B. Other adjunctive therapies may be useful, such as fibrates, bile acid sequestrants and ezetimibe. For BP, the goals should be less than 130 mm Hg systolic and less than 80 mm Hg diastolic, using first-line angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, or second-line calcium antagonists.
What is the consensus statement for prediabetes?
The ACE/AACE consensus statement recommends a two-pronged approach to treating prediabetes: intensive lifestyle intervention, followed by the prevention of CV complications using CV risk reduction medications for abnormal blood pressure and cholesterol, independent of glucose control medications.
What is the ADA prescribed for?
According to the ADA, it is typically prescribed for patients who are at high risk for developing diabetes, including those who have an HbA1c greater than 6%; hypertension; low HDL; elevated triglycerides; family history of diabetes in a first-degree relative; are obese; and are younger than 60 years.
What happens after a patient is verified as a candidate for pharmacological treatment?
After a patient has been verified as a candidate for pharmacological treatment, the proper medication to prescribe must be addressed.
How many people have prediabetes?
Back to Healio. According to the most recent data compiled by the CDC, 57 million U.S. adults have prediabetes, a figure that has reached pandemic levels. “In an ideal world, you want to diagnose high-risk people early in order to prevent progression to full-blown diabetes and its associated complications,” Glenn Matfin, MD, ...
Does prediabetes progress to diabetes?
Whether prediabetes progresses to diabetes depends on a number of variable factors, including lifestyle changes, genetics and treatment practices, which have some physicians supporting the use of medication and others vehemently against it.
Is metformin good after exercise?
With the sheer number of potential patients, this familiarity is essential, Matfin said: “There is a lot of experience with it. So when you’re talking about a population this size of millions and millions and a health care system that is straining, then metformin after diet and exercise would be a good candidate.”
What are the different types of drugs used for diabetes?
Drugs used in diabetes treat diabetes mellitus by lowering glucose levels in the blood. With the exceptions of Insulin, exenatide, liraglutide and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral antihyperglycemic agents. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors. Diabetes mellitus type 1 is a disease caused by the lack of insulin. Insulin must be used in Type I, which must be injected. Diabetes mellitus type 2 is a disease of insulin resistance by cells. Type 2 diabetes mellitus is the most common type of diabetes. Treatments include (1) agents that increase the amount of insulin secreted by the pancreas, (2) agents that increase the sensitivity of target organs to insulin, and (3) agents that decrease the rate at which glucose is absorbed from the gastrointestinal tract. Several groups of drugs, mostly given by mouth, are effective in Type II, often in combination. The therapeutic combination in Type II may include insulin, not necessarily because oral agents have failed completely, but in search of a desired combination of effects. The great advantage of injected insulin in Type II is that a well-educated patient can adjust the dose, or even take additional doses, when blood glucose levels measured by the patient, usually with a simple meter, as needed by the measured amount of sugar in the blood. Insulin Main article: insulin (medication) Insulin is usually given subcutaneously, either by injections or by an insulin pump. Research of other routes of administration is underway. In acute-care settings, insulin may also be given intravenously. In general, there are three types of insulin, Continue reading >>
What is Humana's drug list?
The Drug List is a list of prescription drugs developed and maintained by a medical committee comprised of doctors and pharmacists. The type of coverage your employer purchased may cause variances in drug coverage. Certain drugs may have coverage limitations based on duration or dosage or may require pre-approval. If you have specific questions about a medication or need a drug that does not appear on the list, please call the Customer Care number on the back of your member ID card. Specialty Drug List Your plan's drug coverage may include specialty drugs for chronic and complex illnesses. Many of these medications may be obtained through specialty pharmacies in your network, like Humana Specialty Pharmacy. Members in Puerto Rico need to use CVS/Caremark for specialty drugs. Other pharmacies are available in your network. Humana’s plans give you access to mail delivery pharmacies like Humana Pharmacy®. Humana pharmacy can ship your medications right to your door. With Humana Pharmacy, you can: Fill prescriptions for maintenance medications 3 months at a time. Get possible savings. Receive most medications 10 to 14 days after you place your Humana Pharmacy order, and in 7 to 10 days for a refill. Talk directly to a pharmacist. Pharmacists review each new prescription. For more information, call Humana Pharmacy: 1-800-379-0092. If you use a TTY, call 711. Humana does not determine brand or generic status for the medications on our Drug Lists. A nationally recognized, contracted healthcare vendor with Humana determines whether a drug is classified as a generic or brand-name drug. One of the primary factors for determining Continue reading >>
Why is insulin important?
Insulin is important because it moves glucose, a simple sugar, into the body's cells from the blood. It also has a number of other effects on metabolism. The food that people eat provides the body with glucose, which is used by the cells as a source of energy. If insulin isn't available or doesn't work correctly to move glucose from the blood into cells, glucose will stay in the blood. High blood glucose levels are toxic, and cells that don't get glucose are lacking the fuel they need. There are two main kinds of diabetes: type 1 diabetes and type 2 diabetes. More than 90% of all people with diabetes have type 2. A 2015 Canadian Diabetes Association (CDA) report estimated that about 3.4 million Canadians have diabetes. Only about two-thirds of people with type 2 diabetes are aware of it and are receiving treatment because, for many people, early symptoms are not noticeable without testing. Type 1 diabetes occurs when the pancreas cannot make insulin. Everyone with type 1 diabetes requires insulin injections. Type 2 diabetes occurs when the pancreas does not make enough insulin or the body does not use insulin properly. It usually occurs in adults, although in some cases children may be affected. People with type 2 diabetes usually have a family history of this condition and are most often overweight. People with type 2 diabetes may eventually need insulin injections. This condition occurs most commonly in people of First Nations descent, Hispanics, and North Americans of African descent. Another less common form is gestational diabetes, a temporary condition that occurs during pregnancy. According to the CDA, depend Continue reading >>
Can diabetes be cured?
Diabetes is a life-long disorder that cannot be cured but can be well-controlled and treated with medication and lifestyle changes. Medication in diabetes is not always necessary if you can control your sugar levels naturally. But many people, despite all their efforts, are not able to achieve their target sugar levels. For them, anti-diabetic drugs are needed before moving to insulin therapy. In this article, we discuss indications, side-effects, contraindications and interaction of anti-diabetic drugs or oral medication prescribed in diabetes with inputs from our expert Dr Pradeep Gadge, Diabetologist, Shreya Diabetes Centre, Mumbai. Read more about causes, symptoms, diagnosis and treatment of diabetes. Drugs for diabetes: When is it prescribed for diabetes? Lifestyle modification is the first treatment option for every patient diagnosed with diabetes. If a person has borderline diabetes (fasting glucose slightly greater than 120 mg/dL, post-prandial-200 mg/dL or greater) and has no other risk factors, then diabetes can be controlled well with diet and exercise. But treatment of diabetes has an individualized approach. So it also depends on the kind of lifestyle a person follows and would prefer to follow. For example, a businessman who works 24/7 and doesn’t bother about health is less likely to adhere to dietary changes and exercise regimen. If such a person is diagnosed with borderline diabetes, then I would prescribe medicines. On the other hand, I also get patients who have really high sugar levels, say fasting glucose about 150 mg/dL and post prandial sugar levels about 250 mg/dL, and are ready to follow diet and exercise to control diabetes without taking medicines. Also read about “Diabetes can be cured in the near future,” says Dr Pradeep Gadge. What dr Continue reading >>
Is it better to take diabetes medication or newer?
WHEN it comes to prescription drugs, newer is not necessarily better. And that’s especially true when treating diabetes. One in 10 Americans has Type 2 diabetes. If the trend continues, one in three will suffer from the disease by the year 2050, according to the federal Centers for Disease Control and Prevention. Most Type 2 diabetes patients take one or more drugs to control blood sugar. They spent an estimated $12.5 billion on medication in 2007, twice the amount spent in 2001, according to a study by the University of Chicago. (That figure does not including drugs that diabetics are often prescribed for related health conditions, like high blood pressure and high cholesterol.) Why the increase? More diagnosed patients, more drugs per patient and an onslaught of expensive new drugs, according to Dr. G. Caleb Alexander, assistant professor of medicine at the University of Chicago and lead author of the study. Since 1995, several new classes of diabetes medications have come on the market. Diabetes drugs are important to the pharmaceutical industry, more lucrative than drugs for many other chronic diseases, Dr. Alexander noted in an interview. Simply put, many of these drugs help the body produce less glucose or more insulin, the hormone that shuttles glucose into cells for use as energy, or they increase the body’s sensitivity to its own insulin. Patients and health care professionals have long hoped that as pharmaceutical companies found ways to help the body lower blood sugar, they would produce safer and more efficient alternatives to older medications. But a true breakthrough doesn’t seem to have happened yet. A report released in March by the federal Agency for Healthcare Research and Quality and conducted by researchers at Johns Hopkins University reviewed Continue reading >>
Is Actos a substitute for diabetes?
Diabetes medications (Actos, Avandia, Byetta, Januvia, Janumet, Bydureon, Victoza, and others) are no substitute for a diabetes education and treatment program that includes diet, exercise and the right supplements like chromium or foods that contain nutrients vital to pancreatic function - especially when the risk of these drugs is examined. Medications are just a Band-Aid compared to a healthy diet and carb control, exercise and weight loss, but it’s often easier to take a medication than make changes or to prescribe a pill than to insist on lifestyle changes. And, it’s as much patient responsibility as physician. Having said that, it’s not always easy to eat right or lose weight but relying on a medication can be downright dangerous. Diabetes is the leading cause of blindness, kidney failure, amputations and the seventh leading cause of death. When your body does not produce enough insulin or is resistant to insulin (metabolic resistance), sugars can’t move into your cells, in order to be utilized for energy. ATP production is altered, and the brain is the first organ to suffer. Yet, the costly drugs used to treat diabetes are potentially more dangerous that the disease itself. Relatively new diabetes drugs such as Avandia, Actos, Byetta, Januvia, and others not only have dangerous side effects, many are the hotbed of wrongful death lawsuits. And despite lawsuits and huge settlements most are still on the market. The problem is multidimensional – there is a lack of long term studies although some side effects do not take years to adversely affect patients. Drug companies often skew results to make studies look more promising or even pay other companies to juggle the numbers. Once on the market the FDA is less likely to remove a drug, even if intentional err Continue reading >>
Is metformin a good blood glucose lowering medication?
Metformin has been available in the United States since the mid-1990s, when it received FDA approval. You may also know it by its brand name when it was under patent, Glucophage. Metformin is now widely available as a relatively inexpensive generic medication. Metformin’s main action is to decrease the overproduction of glucose by the liver, a common problem in prediabetes and type 2 diabetes. The action of metformin helps lower blood sugar levels particularly during the night to keep fasting glucose levels under control, but it also helps control blood glucose throughout the day. Metformin also increases the uptake of glucose by your muscles. Overall, metformin decreases insulin resistance and improves insulin sensitivity, thereby helping the insulin your body still makes work more effectively. People with prediabetes and in the early years of type 2 diabetes often continue to make some insulin, just not enough to control blood sugar levels alone. Metformin is not formally approved for use in prediabetes, and any use to treat prediabetes is considered off-label by providers. Since its approval, metformin has become the most commonly recommended blood glucose-lowering medication to treat type 2 diabetes. In recent years it has significantly replaced sulfonylureas, such as glipizide and glyburide. Today both the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the American Association of Clinical Endocrinologists (AACE) generally recommend that people with type 2 diabetes start taking metformin when they are diagnosed to help treat insulin resistance and maximize insulin s Continue reading >>
What is the first class of medications for prediabetes?
The first class are thiazolidinediones, conveniently called TZDs, such as Actos. These are basically anti-insulin resistance medications.
What is the goal of prediabetes management?
Treatment Goals The primary goal of prediabetes management is to normalize glucose levels and prevent or delay progression to diabetes and associated microvascular complications (1,2). Management of common prediabetes comorbidities such as obesity, hypertension, dyslipidemia, cardiovascular disease, and chronic kidney disease is also essential. Therapeutic Lifestyle Management Given its safety and the strength of evidence for its effectiveness in improving glycemia and reducing cardiovascular disease (CVD) risk factors, the preferred treatment approach for prediabetes is intensive lifestyle management (1,2). Therapeutic lifestyle management should be discussed with all patients with prediabetes at the time of diagnosis and throughout their lifetimes. Therapeutic lifestyle management includes medical nutrition therapy (MNT; the reduction and modification of caloric and saturated/hydrogenated fat intake to achieve weight loss in individuals who are overweight or obese), appropriately prescribed physical activity, avoidance of tobacco products, adequate quantity and quality of sleep, limited alcohol consumption, and stress reduction (2). While lifestyle modifications may be difficult to maintain, the following strategies have been shown to increase the likelihood of patient success (1,2): Patient self-monitoring Realistic and stepwise goal setting Stimulus control Cognitive strategies Social support Appropriate reinforcement Primary care providers (PCPs) often take on the responsibility of encouraging behavior changes. The Avoiding Diabetes Through Action Plan Targeting (ADAPT) trial has developed a system that combines evidence-based interventions for behavioral change with existing health record technology to improve primary care providers’ ability to effectively couns Continue reading >>
How many people have prediabetes?
According to the most recent data compiled by the CDC, 57 million U.S. adults have prediabetes, a figure that has reached pandemic levels. “In an ideal world, you want to diagnose high-risk people early in order to prevent progression to full-blown diabetes and its associated complications,” Glenn Matfin, MD, clinical associate professor at New York University and senior staff physician at the Joslin Diabetes Center, told Endocrine Today. Whether prediabetes progresses to diabetes depends on a number of variable factors, including lifestyle changes, genetics and treatment practices, which have some physicians supporting the use of medication and others vehemently against it. “We draw lines in order to differentiate between normal glucose tolerance, prediabetes and diabetes, but it is an interlinked, continuous chain,” Matfin said. “The clock is ticking, and the health risks rise significantly as prediabetes goes untreated.” To examine the current state of prediabetes treatment, Endocrine Today spoke with a number of experts to best understand how lifestyle and pharmacological approaches should be utilized to reverse glucose functions to normal levels. The issue is also examined from a financial aspect, as the ability to keep patients with prediabetes from turning into patients with diabetes translates into hundreds of millions of dollars saved in health care costs. Ralph DeFronzo, MD, and diabetes experts discuss preferred therapeutic approaches for people with prediabetes. Perhaps due to its subtle set of symptoms, the identification and diagnosis of patients with prediabetes has proved to be a challenge. Research has shown that although 30% of the U.S. population had prediabetes in 2005 to 2006, only 7.3% were aware that they had it. A consensus from diabe Continue reading >>
Is prediabetes a type 2 diabetes?
Prediabetes is, for many people, a confusing condition. It’s not quite Type 2 diabetes — but it’s not quite nothing, either. So how concerned should you be about it? For years, the jargon-filled names given to this condition — impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) — may have made the task of taking it seriously more difficult. But in 2002, the American Diabetes Association (ADA), along with the U.S. Department of Health and Human Services, inaugurated the term “prediabetes” to convey the likely result of not making diet or lifestyle changes in response to this diagnosis. In 2003, the threshold for prediabetes was lowered from a fasting glucose level of 110 mg/dl to one of 100 mg/dl. Then, in 2008, the American Diabetes Association (ADA) began recommending the drug metformin for some cases of prediabetes — specifically, for people under age 60 with a very high risk of developing diabetes, for people who are very obese (with a body-mass index, or BMI, of 35 or higher), and for women with a history of gestational diabetes. The ADA also said that health-care professionals could consider metformin for anyone with prediabetes or an HbA1c level (a measure of long-term blood glucose control) between 5.7% and 6.4%. But according to a recent study, metformin is still rarely prescribed for prediabetes. The study, published in April in the journal Annals of Internal Medicine, found that only 3.7% of people with prediabetes were prescribed metformin over a three-year period, based on data from a large national sample of adults ages 19 to 58. According to a Medscape article on the study, 7.8% of people with prediabetes with a BMI of 35 or higher or a history of gestational diabetes were prescribed metformin — still a very low rate for t Continue reading >>
Does metformin help with prediabetes?
Do you have prediabetes? You might be able to ward it off with the help of one of the diabetes drugs. Metformin might stop you from getting diabetes and could also help you in other ways. But persuading your doctor to prescribe it could be a challenge. The biggest and perhaps the best study of people who have prediabetes showed that taking metformin cuts the risk of diabetes by 31 percent. While this was less than the reduction of 58 percent that the “lifestyle intervention” provided, in real life we usually aren’t able to get that much guidance from our medical team. By “lifestyle intervention” the researchers meant being in a program that provided information, guidance, and support to help participants lose 7 percent or more of their weight and to get moderately intense physical activity — like brisk walking — for at least 150 minutes a week. But without that guidance, it typically takes a long time to help, and in fact it most people just don’t do it. Who Metformin Helps Most The study showed that metformin helped the most among younger people, and with people who had a high body mass index (BMI) or a high fasting blood glucose level. It doesn’t help seniors much. But the biggest problem with metformin is to have your doctor prescribe it. Only 3.7 percent of insured adults who had a prediabetes diagnosis were taking it between 2010 and 2012, according to a study that the Annals of Internal Medicine published last year. This very low proportion is probably because the U.S. Food and Drug Administration hasn’t approved metformin — or any other drug — for prediabetes. While doctors are free to prescribe it “off label,” some of them are hesitant to do that. Some Side Effects Like any drugs, metformin sometimes has unwanted side effects. The mos Continue reading >>
Is metformin good for diabetes?
The oral biguanide metformin (Glucophage, and others) is generally the drug of choice for initial treatment of type 2 diabetes. It has also been used to prevent or at least delay the onset of diabetes in patients considered to be at high risk for the disease. Recent guidelines recommend considering use of metformin in patients with prediabetes (fasting plasma glucose 100-125 mg/dL, 2-hr post-load glucose 140-199 mg/dL, or A1C 5.7-6.4%), especially in those who are <60 years old, have a BMI >35 kg/m2, or have a history of gestational diabetes.1 Metformin has not been approved for such use by the FDA. CLINICAL STUDIES — In the Diabetes Prevention Program (DPP) trial, 3234 nondiabetic adults with a BMI ≥24 kg/m2 (≥22 kg/m2 in Asian patients) and elevated fasting and post-load plasma glucose concentrations were randomized to receive intensive lifestyle intervention focusing on weight loss and exercise, metformin 850 mg twice daily, or placebo.2 After a mean follow-up of 2.8 years, the incidence of diabetes was reduced, compared to placebo, by 58% with intensive lifestyle intervention and by 31% with metformin. Metformin was as effective as lifestyle intervention among patients <60 years old or with a BMI ≥35 kg/m2. When the 3-year DPP trial ended, the intensive lifestyle intervention group was offered semi-annual counseling and the metformin group could continue to take the drug. During a follow-up of 15 years, the average annual incidence of diabetes, compared to placebo, was 27% lower in patients originally randomized to lifestyle intervention and 18% lower in those randomized to metformin.3 ADVERSE EFFECTS — No significant safety issues have been detected with long-term use of metformin. The drug can cause adverse gastrointestinal effects such as metallic taste Continue reading >>
Can prediabetes be treated with insulin?
Yes. No. Kinda. OK, here’s the deal, the FDA hasn’t actually approved any medications for prediabetes, but doctors commonly prescribe two classes of medications “off label” to help treat the condition. The first class are thiazolidinediones, conveniently called TZDs, such as Actos. These are basically anti-insulin resistance medications. As prediabetes is a growing problem of insulin resistance, a medication to fight insulin resistance is a logical fit to try and prevent what we call conversion—that is moving from prediabetes to full-blown diabetes. The thought is that by reducing insulin resistance you can reduce overwork on the part of the pancreas (which is working overtime to try and overwhelm the insulin resistance) and thus delay the “burnout” of the pancreas that causes diabetes. The other class of drugs that seem to help are biguanides, such as Metformin. Met has a small effect on insulin resistance but for the most part attacks another part of the prediabetes equation which is the liver’s tendency to over produce hormones that raise the blood sugar level. There is also one other prescription for prediabetes that isn’t really a medication at all, but it works very well, and that is to lose some weight. Most people with prediabetes are overweight (you know who you are), and the more you weigh the more resistant your body is to the insulin you make, which means you need to make more, and so on. Hold on, hold on. Don’t stop reading yet! I can feel you tuning me out! I didn’t say you have to get skinny and svelte. Every little bit of weight you lose can lower your insulin resistance. Another way of thinking about that is that each pound you drop pushes diabetes further into the future. And that’s a prescription worth filling. Continue Learnin Continue reading >>
