The Pharmaceutical Journal
Vol 268 No 7185 p197-203
16 February 2002

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New England Journal of Medicine (content.nejm.org)

Metformin and lifestyle changes can prevent type 2 diabetes

Treatment with metformin and modification of lifestyle are two effective means of delaying or preventing type 2 diabetes, American researchers say.

They randomly assigned 3,234 people who were at risk of developing diabetes to placebo, metformin (850mg twice daily), or a life-style modification programme with at least 150 minutes of physical activity per week aimed at producing a weight loss of at least 7 per cent. They found that the incidence of diabetes after an average of 2.8 years of follow-up was 11.0, 7.8 and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. "Our results support the hypothesis that type 2 diabetes can be prevented or delayed in persons at high risk for the disease," they say.

They found that the effects were similar in men and women and in all racial and ethnic groups included in the study. The lifestyle intervention was also as effective in older people as in younger people. Metformin was less effective in subjects with a lower base-line body-mass index or a lower fasting glucose concentration than in those with higher values for these variables.

The researchers report that the rate of gastrointestinal symptoms was highest in the metformin group, and the rate of musculoskeletal symptoms was highest in the lifestyle intervention group. Rates of other adverse events, admission to hospital and mortality were similar in the three groups.

"If the study's interventions were implemented among [people at high risk for diabetes] there would be a substantial reduction in the incidence of diabetes," they conclude (New England Journal of Medicine 2002;346:393).