One In Twelve Americans Should Be on Metformin

A study was done to determine the proportion of the American population who would merit metformin treatment, according to recent ADA consensus panel recommendations, to prevent or delay the development of diabetes.

Risk factors were evaluated in 1581 SIGT, 2014 NHANES III, and 1111 NHANES 2005-2006 subjects, who were non-Hispanic white and black, without known diabetes.

The criteria for consideration of metformin included the presence of both IFG and IGT, with >/=1 additional diabetes risk factor: age /=35 kg/m(2), family history of diabetes, elevated triglycerides, reduced HDL-cholesterol, hypertension, or A1c >6.0%.

The results showed IFG and IGT, and IFG+IGT were found in 18.0%, 7.2%, and 8.2% of SIGT; 22.3%, 6.4%, and 9.4% of NHANES III; and 21.8%, 5.0%, and 9.0% of NHANES 2005-2006 subjects, respectively. In SIGT, NHANES III, and NHANES 2005-2006, criteria for metformin consideration were met in 99%, 96%, and 96% with IFG+IGT, 31%, 29%, 28% of all IFG, and 53%, 57%, and 62% of all IGT — 8.1%, 9.1%, and 8.7% of all subjects, respectively.

From the results it was concluded that over 96% of individuals with both IFG and IGT are likely to meet ADA consensus criteria for consideration of metformin. Since over 28% of all of those with IFG met criteria, providers should perform OGTTs to find concomitant IGT in all patients with IFG. To the extent that our findings are representative of the U.S. population, approximately 1 in 12 adults has a combination of prediabetes and risk factors which may justify consideration of metformin treatment for diabetes prevention.

Diabetes Care. 2009 Oct 6. [Epub ahead of print]