Metformin Indications in Pre Diabetes.
Adults at high risk whose blood glucose measure (fasting plasma glucose or HbA1c) shows they are still progressing towards type 2 diabetes, despite their participation in an intensive lifestyle-change programme. Adults at high risk who are unable to participate in lifestyle-change programmes because of a disability or for medical reasons.
What action should be taken? Doctors, non-medical prescribers and pharmacists in primary and secondary healthcare should use clinical judgement on whether (and when) to offer standard-release metformin to support lifestyle change for people whose HbA1c or fasting plasma glucose blood test results have deteriorated, if:
this has happened despite their participation in an intensive lifestyle-change programme, or they are unable to participate in an intensive lifestyle-change programme.
They should also: Discuss with the person the potential benefits and limitations of taking metformin, taking into account their risk and the amount of effort needed to change their lifestyle to reduce that risk.
Explain that long-term lifestyle change can be more effective than drugs in preventing or delaying type 2 diabetes.
Encourage them to adopt a healthy diet and be as active as possible. Where appropriate, stress the added health and social benefits of physical activity (for example, point out that it helps reduce the risk of heart disease, improves mental health and can be a good way of making friends).
Advise them that they might need to take metformin for the rest of their lives and inform them about possible side effects.
Continue to offer advice on diet and physical activity along with support to achieve their lifestyle and weight-loss goals.
Check the person's renal function before starting treatment, and then twice yearly (more often if they are older or if deterioration is suspected).
Start with a low dose (for example, 500 mg once daily) and then increase gradually as tolerated, to 1500–2000 mg daily. If the person is intolerant of standard metformin consider using modified-release metformin.
I prefer MR METFORMIN 250 mg to start with for atleast 3 -4 weeks, and then reassess if the drug suits them. I am not keen on MR Metformin dose in excess of 1500mg, in South Asians.
Prescribe metformin for 6–12 months initially. Monitor the person's fasting plasma glucose or HbA1c levels at 3-month intervals and stop the drug if no effect is seen.
G Mohan.
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