Medication for Prediabetes

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Prediabetes is a condition with higher-than-normal blood sugar levels.
You may not feel sick or have any symptoms, but having prediabetes puts you at higher risk for developing type 2 diabetes within a few years. About 5 to 10% of people with prediabetes develop diabetes each year, and 90% of people with prediabetes will develop diabetes within the next 20 years.

Prediabetes treatments can lower your risk for diabetes and complications of diabetes. Lifestyle modifications, such as losing extra weight and increasing physical activity, are the most effective approaches for most people. 

Certain medications can also help delay the onset of type 2 diabetes or prevent it altogether. Metformin is the most common blood sugar-lowering medication for prediabetes, but there are others. These prescription medications are only for some patients with prediabetes, and they work best when you also adapt a healthy lifestyle.

 

Prediabetes Treatment Approaches: Lifestyle and Medication


Prediabetes treatment has three main components.

  1. Lifestyle modification to make healthy behavior choices in daily life.

  2. Prediabetes medication(s) to control blood sugar and/or increase insulin sensitivity.

  3. Screening and any necessary treatment for high blood pressure and high cholesterol.

Lifestyle Modification: The American Diabetes Association (ADA) recommends that people with prediabetes take part in a lifestyle intervention program. This can be a Centers for Disease Control and Prevention (CDC)-Recognized Diabetes Prevention Program (DPP) with a focus on weight loss and physical activity. Eating well and getting enough sleep are examples of other healthy choices that can lower blood sugar.

Prediabetes Medication: Medications can help lower blood sugar and reduce type 2 diabetes risk. Metformin is most common, but there are other types of prediabetes medications that are sometimes prescribed. You are more likely to have prediabetes medications if you are at higher risk for diabetes or if you have not been able to control your prediabetes with lifestyle modifications.

Blood Pressure and Cholesterol Screening: Prediabetes and diabetes are risk factors for high blood pressure and high cholesterol. In turn, those can lead to stroke, kidney disease, and heart disease. Your prediabetes treatment plan may include regular blood pressure measurements and blood tests for cholesterol levels. Prescription medications may be necessary to control your numbers.

 

Most Common Medications for Prediabetes


Classes of medications for patients with prediabetes include biguanides, thiazolidinediones, and α-Glucosidase Inhibitors.[2]  The best-known biguanide may be metformin, with Glucophage being the most common brand name. Metformin lowers glucose levels in a few ways.[3]

  • It increases insulin sensitivity in your liver to decrease your body’s glucose production.

  • It increases insulin sensitivity in skeletal muscle, which allows your muscle cells to remove glucose from the bloodstream to lower blood sugar levels.

  • It increases anaerobic respiration, which uses glucose, in your gastrointestinal cells.

  • It increases glucagon-like peptide-1 (GLP-1) and beta cell GLP-1 receptors, which lowers blood glucose.

Metformin also improves cholesterol levels and may help you control your weight. It only appears to aid in a few pounds of weight loss and benefits may only last for a few months to a year, but that is better than most other diabetes medications, which can lead to weight gain.

There are other possible medications for prediabetes. Thiazolidinediones increase insulin sensitivity. They also lower blood glucose by increasing glucose metabolism, but they do this by reducing fat metabolism, and weight gain can occur. Thiazolidinediones raise “good” HDL cholesterol, but there are concerns with heart health because they also raise “bad” LDL cholesterol. Rosiglitazone and pioglitazone are examples of thazolidinediones.

The α-Glucosidase inhibitors are medications that interfere with the digestive process. They inhibit the action of α-Glucosidase, which is an enzyme that breaks down carbohydrates, such as table sugar and starches in foods, into glucose. The result is that less glucose gets into your bloodstream after you eat. Side effects of these medications can include flatulence and diarrhea.

 

Weight Loss in Prediabetes


For most people who have prediabetes and are overweight or obese, weight loss can greatly reduce your risk of type 2 diabetes. Weight loss can be daunting if you take an all-or-nothing approach, but it’s not necessary to lose 100 lb. to benefit. Every pound you lose helps prevent or delay type 2 diabetes.

  • Losing 2.2 lb. (1 kg) lowers your risk of developing type 2 diabetes by 16%.

  • Losing 5 to 7 percent of body weight lowers your risk by over 50%. That is 8 to 11 lb. if you start at 160 lb., or 10 to 14 lb. if you currently weigh 200 lb.

  • Hitting a “healthy/normal” weight if you are currently overweight or obese further reduces your risk.

Weight loss only lowers diabetes risk for as long as you keep off the weight. That means that your prediabetes weight loss plan should consider your ability to stick to your plan for the long-term. Here are a few do’s and don’ts of a prediabetes weight loss plan.

 

DO

  • Increase consumption of vegetables and lean proteins to stay full on fewer calories.
  • Fewer staff needed per patient, so lower costs.
  • Choose water and low-calorie beverages instead of sugar-sweetened ones.
  • Make small changes, such as removing fat from meat, taking skin off chicken, and choosing whole instead of refined grains.
  • Limiting sugary foods and desserts.
  • Allow for special occasions, restaurant meals, and occasional treats.
  • Take smaller portions of restaurant meals and high-calorie or high-sugar foods.
  • Track your food intake.
  • Plan ahead so you always have a healthy option available.
  • Be active most days.

DON’T

  • Depend on bars, shakes, cookies, and other processed meal replacement diet products.
  • Expect to lose a lot of weight quickly. Lose it slowly to increase your chances of keeping it off.
  • Start a diet without asking your doctor.
  • Skip meals, especially breakfast.
  • Depend on fast food or processed ready-to-eat meals and snacks.
  • Try to over-exercise to compensate for any over-eating.
 

Metformin is one of the few diabetes medications that helps with weight loss; the other ones can lead to weight gain. Metformin’s weight loss effect is small – about 2 percent of body weight, or about 3 lb. if you weigh 150 lb. – but every little bit helps. Metformin can promote weight loss by reducing your appetite so you eat less. It can also increase your calorie burn during exercise[4]. It is important to understand that metformin only helps you lose weight if you follow a diet and exercise program for weight loss.

 

Exercise for Prediabetes


Exercise burns calories and helps with weight loss, but it does far more for prediabetes beyond its weight loss effects. Exercise increases insulin sensitivity in your muscles so they take up more glucose from the blood and lower blood sugar. The effects last for 24 hours, and that is great incentive to get active every day.

How much do you need, and what counts? Any increase you make in your daily activity levels can help. The general goal is 150 minutes per week of moderate to vigorous-intensity aerobic physical activity, plus 2 to 3 sessions per week of strength training, such as with weights, body weight, resistance bands, or medicine balls.

It is not hard to get started. Almost anything counts, whether you walk, jog, swim, cycle, garden, or dance. As little as 5 minutes at a time helps, too. Just be sure to ask your doctor before you get started, and choose exercises that are safe and comfortable for you.

 

Medication versus Weight Loss and Exercise for Prediabetes


What is better: a pill or a lifestyle change? Can either of them really work, or are you going to get diabetes regardless of what you do? Researchers asked those very questions and set out to answer them in a clinical trial that compared metformin to lifestyle changes to a control group among participants with prediabetes. They made some important discoveries.[5]

  • You can prevent diabetes! Most cases of diabetes are largely preventable if you treat your prediabetes properly.

  • Metformin lowered risk of diabetes by 31% compared to the control group.

  • Lifestyle changes lowered risk of diabetes by 58% compared to the control group.

This study and similar ones have consistently shown that lifestyle changes, such as losing weight and getting active, are the most effective strategies for lowering blood sugar and preventing diabetes for most people. Most people who are diagnosed with prediabetes are likely to receive a recommendation to make healthier choices before their doctors decide to prescribe medications.

You are more likely to be prescribed metformin for prediabetes if your body mass index (BMI) is over 35, if you had gestational diabetes (diabetes that came during pregnancy and then left), or you are younger than 60 years old. Your doctor may also ask you to consider metformin if lifestyle changes have not worked to bring down your blood sugar levels.

 
Medications Weight Loss and Exercise
Recommended for
High-risk patients
Nearly all patients
Effect on Diabetes Risk
31% lower type 2 diabetes risk over 2.8 years
58% lower type 2 diabetes risk over 2.8 years (Diabetes Prevention Program)
Effect on Blood Sugar
Lowers it
Lowers it
Side Effects
Gastrointestinal discomfort, hypoglycemia, possible weight gain
Negative effects are unlikely. Positive side effects can include better energy, mood, sleep, and focus.
Safety
Possible complications such as liver disease and heart disease
Safe if done cautiously
Other Health Effects
Risk of vitamin B12 deficiency
Lowered risk for heart disease, certain cancers, Alzheimer’s disease, stroke, depression, and more
 

Healthy Lifestyle Changes: Diabetes Prevention Program


The lifestyle intervention in that landmark clinical trial was a Diabetes Prevention Program (DPP). The DPP focuses on hitting weight loss of 5 to 7% of starting weight and achieving 150 minutes per week of physical activity. It is a year-long program that includes 16 lessons in the first 6 months and another 6 lessons in the final 6 months.

There are many DPP providers nation-wide, and many healthcare providers offer them as a benefit. Lark DPP is recognized by the Centers for Disease Control and Prevention (CDC) as a fully online program. You can access it at your convenience with no need to travel to in-person meetings on a specific schedule. Lark’s program is personalized and designed to help you not only with weight loss and physical activity, but also with healthy eating, stress management, better sleep, and motivation.

 

Healthy Eating and Other Natural Remedies for Prediabetes


Losing weight and getting active are the two most effective strategies for lower blood sugar and diabetes risk, but there are other natural prediabetes remedies. Healthy eating, aside from whether you lose weight, can lower blood sugar. So can managing stress, getting adequate sleep, and certain dietary supplements.

Healthy eating for prediabetes means eating more of the foods that lower blood sugar and insulin resistance, and less of the ones that increase those measures. In general, look for fresh foods, fiber, healthy fats, and lean proteins. When you can, limit sugary foods, refined starches, fast foods, fried foods, and highly processed foods.

 

Choose

  • Vegetables
  • Beans, lentils, and other legumes
  • Whole grains
  • Fish, eggs, chicken, and other proteins
  • Low-fat yogurt and cheese
  • Fresh fruit
  • Nuts
  • Avocados

Limit

  • Candy, desserts, jelly
  • Sugar-sweetened beverages
  • White bread and other refined grain products, such as white rice and pasta
  • French fries, fried chicken, doughnuts, chips, and other fried foods
  • Red meat, bacon, and processed meat

Dietary and nutritional supplements could help lower blood sugar or raise insulin sensitivity, but research is ongoing. Ask your doctor before taking any supplements, since they can have side effects or may not be effective. Cinnamon, chromium, Gymnema sylvestre, and bitter melon are a few of the more common nutritional supplements for blood sugar.

If you have prediabetes, it is worth taking steps to treat it because you can greatly lower your risk for type 2 diabetes. Medications for prediabetes are a strategy that can help, but they are more effective with lifestyle treatments, and may not even be necessary. Talk to your doctor about your options, and see if a DPP such as Lark can help you turn healthy choices into habits that can change your life.

 


 Reference

  1. 5. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes—2018. American Diabetes Association. Diabetes Care 2018 Jan; 41(Supplement 1): S51-S54. http://care.diabetesjournals.org/content/41/Supplement_1/S51

  2.  Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6(2):296-303. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360422/

  3.  Hostalek U, Gwilt M, Hildemann S. Therapeutic Use of Metformin in Prediabetes and Diabetes Prevention. Drugs. 2015;75(10):1071-94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498279/

  4.  Diabetes Prevention Program Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care. 2012;35(4):731-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3308305/

  5.  Diabetes Prevention Program Research Group. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med 2002; 346:393-403. DOI: 10.1056/NEJMoa012512. https://www.nejm.org/doi/full/10.1056/NEJMoa012512

When Is Prediabetes Confirmed?


Prediabetes affects 1 in 3 Americans, including half of those over age 65. Only 8 to 14% of those with prediabetes know they have it, so how do you know if you do? You can easily be confused about whether you have prediabetes, especially if any of the following sound familiar.

  • Your doctor says, “You may have prediabetes.” (Huh? Do you, or do you not, have prediabetes?)

  • You do not feel sick. (So it is really possible that you might have a chronic condition that puts you at risk for type 2 diabetes)?

  • Your doctor says that your blood sugar is, “a little high.” (Compared to what?)

  • Your doctor tells you that you are at high risk for diabetes because you are overweight or had gestational diabetes (diabetes during pregnancy). (Is that the same as having prediabetes)?

It is important to know if you have prediabetes because treatment can be effective for preventing or delaying the onset of type 2 diabetes. Here is how you can test for prediabetes and when it is confirmed.

 

Random Blood Glucose Test


There is a chance that your healthcare provider might suspect that you have prediabetes due to certain risk factors. These can include:

  • Being overweight or obese.

  • Being 45 years or older.

  • Having a family history of type 2 diabetes.

  • Being of a high-risk ethnicity, such as African American, Latino, Native American, or Pacific Islander.

  • Being physically inactive.

In some cases, your provider’s first step may be to order what is called a random blood glucose (or blood sugar) test. This test will not confirm prediabetes, but it can help your doctor determine whether to continue testing for prediabetes. It is a good first step because it is an easy and convenient test. You can take it any time and do not need to fast for it[1].

Test Value Result
Fasting Blood Glucose (FBG)
Under 100 mg/dl
Normal
Fasting Blood Glucose (FBG)
100-125 mg/dl
Prediabetes
Fasting Blood Glucose (FBG)
Over 125 mg/dl
Diabetes
Glycated hemoglobin (hemoglobin A1C or A1C)
Under 5.7%
Normal
Glycated hemoglobin (hemoglobin A1C or A1C)
5.7 to 6.4%
Prediabetes
Glycated hemoglobin (hemoglobin A1C or A1C)
Over 6.4%
Diabetes
Oral glucose tolerance test (OGTT)
Under 140 mg/dl
Normal
Oral glucose tolerance test (OGTT)
140-199 mg/dl
Prediabetes
Oral glucose tolerance test (OGTT)
Over 199 mg/dl
Diabetes
 

The random glucose test cannot confirm prediabetes. It is a good screening test to alert you to the possible need for a true diagnostic test. You should get your blood sugar tested again if your random glucose test is out of range. Your healthcare provider might suggest a fasting blood glucose test, a glycated hemoglobin (A1C) test, or an oral glucose tolerance test (OGTT). 

 

Tests for Prediabetes


According to the American Diabetes Association (ADA)[2], there are three possible tests that can show that you have prediabetes.

  1. Fasting blood glucose (FBG)

  2. Glycated hemoglobin (hemoglobin A1C or A1C)

  3. Oral glucose tolerance test (OGTT)

  4. CDC prediabetes risk screening test (unofficial)

A fasting blood glucose (FBG) test measures your blood sugar level at a single moment in time. You get your blood drawn after an overnight (usually 8 to 12 hours) fast without eating or drinking anything with calories.

Glycated hemoglobin (hemoglobin A1C or A1C) gives a picture of your average blood glucose levels over the past three months. You do not need to fast for your A1C test, and it only requires a blood draw.

The oral glucose tolerance test (OGTT) checks how well your body processes sugar. The test takes a little longer than the FBG and A1C tests. You go to the lab after an overnight fast and get your blood drawn. Then you drink a liquid solution containing 75 grams of glucose (a type of sugar). Wait for 2 hours, without eating or drinking anything else, and get your blood drawn again. Be aware that the sugary solution is so sweet that some people have trouble drinking it. It has the amount of sugar in 2 cans of a soft drink or 5 toaster pastries. 

You can get any of the above blood tests at most regular labs or clinics where you get your other blood tests such as cholesterol levels. Be sure to check whether you need to make an appointment, especially for the OGTT.

 

Instant Online Diabetes Risk Screening


A blood test may not be that bad, but what if you could get a good idea of your prediabetes risk:

  • Instantly,

  • Online, and

  • Without needles?

You can, with the test right here on Lark’s website. The Centers for Disease Control and Prevention (CDC) developed a prediabetes risk test to assess your diabetes risk. It asks about risk factors such as your family history of diabetes, your weight, your age, and other risk factors for prediabetes. Within seconds, you can get a score that correlates with your risk for prediabetes. If you are at high risk, the CDC suggests getting a blood test to check if you have prediabetes.

 

Confirmation with a Second Test


If your first test result suggests that you may have prediabetes, your healthcare provider will probably order a repeat test to confirm that you have prediabetes. Prediabetes can only be confirmed if your second test is in the prediabetes range again. 

Having the second test helps make sure that your first test is not a mistake. The first test could have been misleading because of a lab error, for example. Other ways the first test could be wrong is if you accidentally ate instead of fasted before an OGTT or FBG or if you were slightly dehydrated when you took your test.

The moment the results of your second test also indicate that you have prediabetes, prediabetes is confirmed.

 

Prediabetes Test Values


Your healthcare provider should have the final say about whether you have prediabetes, but the ADA provides guidelines for diagnosing prediabetes with blood glucose, A1C, and OGTT tests.

Test Value Result
Fasting Blood Glucose (FBG)
Under 100 mg/dl
Normal
Fasting Blood Glucose (FBG)
100-125 mg/dl
Prediabetes
Fasting Blood Glucose (FBG)
Over 125 mg/dl
Diabetes
Glycated hemoglobin (hemoglobin A1C or A1C)
Under 5.7%
Normal
Glycated hemoglobin (hemoglobin A1C or A1C)
5.7 to 6.4%
Prediabetes
Glycated hemoglobin (hemoglobin A1C or A1C)
Over 6.4%
Diabetes
Oral glucose tolerance test (OGTT)
Under 140 mg/dl
Normal
Oral glucose tolerance test (OGTT)
140-199 mg/dl
Prediabetes
Oral glucose tolerance test (OGTT)
Over 199 mg/dl
Diabetes
 

When to Get Tested for Prediabetes


You should get tested for prediabetes if you or your doctor thinks you may have high blood sugar. This could be if you have symptoms, but symptoms of prediabetes are rare. Instead, the National Institutes of Health recommends getting tested for prediabetes if you are overweight or obese and have one or more of the following risk factors[3].

  • You are physically inactive.

  • You had gestational diabetes (diabetes while you were pregnant) or you gave birth to a high-birth-weight baby.

  • You have high blood pressure or cholesterol or you have heart disease.

  • Your ethnicity is Pacific Islander, American Indian, African American, Alaska Native, Asian American, or Hispanic/Latino.

You should also get tested if you have family members with prediabetes or if you are at least 45 years old.

 

What If Prediabetes Is Confirmed?


Having prediabetes may put you at higher risk for developing type 2 diabetes, but you can fight back. Prediabetes treatment that includes nothing but lifestyle modifications can be effective.

  • It could put your blood sugar levels back to normal so that you do not have prediabetes anymore.

  • It could prevent type 2 diabetes so that you do not have to monitor your blood sugar levels each day.

  • It could delay the onset of type 2 diabetes, which can lower your lifetime risk for diabetes complications.

  • It could make diabetes medications more effective, should you need them, and allow you to take lower doses.

Your doctor should follow up with you to make a prediabetes treatment plan after prediabetes is confirmed. Healthy lifestyle changes are the core of prediabetes treatment. They can lower your risk for type 2 diabetes by over 50%.

Losing extra weight and increasing your physical activity are two of the most effective changes you can make to reduce insulin resistance and lower high blood sugar. Losing as little as a few pounds can lower your risk for diabetes by several percent, and losing 5 to 7% of your body weight, or about 8 to 14 lb. for many people, can cut diabetes risk by half. 

Physical activity recommendations to increase insulin sensitivity and lower diabetes risk include getting at least 150 minutes per week of aerobic activity. Examples include brisk walking, hiking, swimming, cycling, group fitness classes, and raking leaves. You can get further benefits with resistance training such as lifting weights or using resistance bands.

 

Follow-Up Blood Sugar Testing


If your blood sugar was normal according to your fasting blood glucose, A1C, or OGTT test, you should retest in 3 years as long as no other health conditions change. If you have prediabetes, you should have follow-up testing at least every 2 years to see if you have developed diabetes. Testing should be more frequent if you are having trouble controlling your blood sugar.

 

Diabetes Prevention Program


The national Diabetes Prevention Program (DPP) promotes weight loss and physical activity and has been proven to lower diabetes risk. It includes a curriculum approved by the CDC and is designed to take a year to complete. You may be eligible to participate in a DPP without cost.

Lark DPP is available through your smartphone so you can access it anytime. You can get coaching not only on weight loss and exercise, but also on other health behaviors that lower diabetes risk. These include stress management, getting adequate sleep, and eating healthier. Each Lark user has a customized program with instant feedback and smart reminders.

Testing for prediabetes can alert you to a health problem and give you the chance to take care of it early. Once prediabetes is confirmed, you can take steps to prevent diabetes and improve your health

 

Reference

  1. Healthline. Random Glucose Testing. https://www.healthline.com/health/type-2-diabetes/random-glucose-testing#glucose-testing. Reviewed June 28, 2018. Accessed January 2, 2019.

  2.  Standards of Medical Care in Diabetes. https://diabetesed.net/wp-content/uploads/2017/12/2018-ADA-Standards-of-Care.pdf Accessed January 2, 2019

  3.  Insulin Resistance & Prediabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance. May 2018. Accessed January 2, 2019.