Does Metformin Only Benefit Highest-Risk Diabetes Patients?

The benefits of metformin for diabetes prevention vary widely between patients, and may be limited to only the highest-risk patients, according to data from the Diabetes Prevention Program trial.

For the study, researchers evaluated 3081 patients without diabetes who displayed impaired glucose metabolism. The intervention groups were administered a placebo, metformin, or a lifestyle modification program that focused on physical activity and weight loss.
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Participants were separated into quartiles or baseline risk based on hemoglobin A1c levels and fasting plasma glucose.

Overall, 21% (655) of participants manifested diabetes over an average 2.8-year follow-up.

Although the benefits of lifestyle intervention were 6 times greater in the highest risk quartile than in the lowest risk quartile, participants in the lowest quartile still received a significant benefit.

However, metformin’s benefits were seen almost exclusively in the top quartile of participant and no benefit was observed in the lowest quarter.

“Patients at high risk of diabetes have substantial variation in their likelihood of receiving benefit from diabetes prevention treatments. Using this knowledge could decrease overtreatment and make prevention of diabetes far more efficient, effective, and patient centered, provided that decision making is based on an accurate risk prediction tool,” said the study’s authors.

The complete study is published in the February issue of the British Medical Journal.

-Michelle Canales Butcher

Reference:

Sussman JB, Kent DM, Nelson JP, et al. Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of diabetes prevention program. BMJ. 2015 February [epub ahead of print] doi: http://dx.doi.org/10.1136/bmj.h454.