Pharmacological management of prediabetes
Metformin
In 2017, NICE recommended metformin to support lifestyle changes where:
- HbA1c or fasting plasma glucose has worsened despite participation in intensive lifestyle change programmes
- A patient is unable to participate in an intensive lifestyle change programme (e.g. due to mental illness, dementia, poor physical health or with BMI >35kg/m2).
The maximum suggested dose of metformin is 1.5g-2g per day. Renal function should be checked before starting treatment and then twice yearly or more frequently if renal function deteriorates.
Glucophage SR is licensed in the UK for preventing diabetes but NICE recommends initial use of standard release metformin and a change to the modified release preparation for those intolerant of standard release metformin.
Orlistat
Where clinically appropriate, orlistat can be used as part of the management of prediabetes for managing obesity in people with BMI ≥28kg/m2. The use of orlistat should be reviewed after 12 weeks with consideration to discontinue if the person has not lost at least five per cent of their original body weight.
Common side-effects associated with orlistat are gastrointestinal such as abdominal pain and flatulence. People usually develop tolerance to the gastrointestinal effects after prolonged use.