The other, often less talked-about insight of the original DPP study was that metformin alone showed significant reduction in the progression of prediabetes to type 2 diabetes. While many experts argue that lifestyle intervention should be the first step in any case and that dietary change and physical activity are feasible, we should be thinking more about the possibility of metformin, and other potential therapies for diseases like obesity, as a preventive backup or alternative in those cases where lifestyle interventions fail or make less sense. Among other things, metformin is also relatively “dirt cheap,” to borrow a phrase from Dr. Nick Wilkie, Resident Physician in Emergency Medicine at University of Wisconsin, Madison.
The major challenge, of course, is that metformin is not currently indicated for prevention, so only limited data exist on how, when, and for whom it is best used as a preventive intervention. Professor Kamlesh Khunti, Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester, UK, said that there might be great value in research that examines who is more likely to benefit from lifestyle interventions versus metformin, as patients could be directed to the most effective strategy earlier.