As a side-gig, I do a little stock trading & often listen to business news snippets that Alexa plays with my morning coffee. Some time ago Silicon valley tech guys taking Metformin as a “anti-ageing” pill made the news. Caloric restriction in any form, including intermittent fasting, is showing benefits that could result in life-extension and Metformin can simulate fasting without actually fasting. Indeed the TAME clinical trial is in the works to show that Metfomin can delay ageing in humans. While it has garnered attention slowing ageing, it’s very underused for what it’s proven to help – Prediabetes !
Pre-diabetes defined by ADA as Hb-A1c 5.7% to 6.5% , which is a simple, indirect blood test to see what your glucose has been averaging for the last 3 months. The CDC recommends A1C testing every 1-3 years depending on age. The usual advice is if you have prediabetes then it’s diet, exercise & weight loss as therapy. A good trifecta of advice, but in reality, life happens ! Ability to take consistent efforts with a happy motivated mindset is not a luxury for all – especially when eating healthy is expensive.
Studies have shown Metformin to prevent progression to diabetes in high risk prediabetics, but Metformin is seldom used for this purpose. It’s benefit is not uniform across all patients however and that’s why you might see some anti-Metformin advice on some articles. What we do know is Metfomin for diabetes prevention works best in : Young & obese, those with higher fasting glucose, women with gestational diabetes history and those that score high on diabetic risk calcultors such as American Diabetes association risk calculator. Score or 5 or more in a prediabetic should be considered for Metformin treatment.
💡 If you diagnose someone with prediabetes, also calculate their diabetes risk. In high-risk prediabetics, consider Initiating Metformin at low doses (e.g. 250mg daily) and titrate up to a tolerated dose upto 875-1000mg BID over a few months. While cheap & safe, patients should be educated about risks and screened for these regularly (e.g Screen for B12 deficiency before & every 1-2 years after while keeping an eye on renal function). Remember to tell them that diet, exercise & weight loss is still mandatory.
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