Many Americans Have Pre-Diabetes and Should Be Considered for Metformin Therapy
- Mary K. Rhee, MD1,
- Kirsten Herrick, MSC2,
- David C. Ziemer, MD1,
- Viola Vaccarino, MD, PHD3,
- William S. Weintraub, MD4,
- K.M. Venkat Narayan, MD5,6,
- Paul Kolm, PHD4,
- Jennifer G. Twombly, MD, PHD1 and
- Lawrence S. Phillips, MD1,7
- 1Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia;
- 2Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia;
- 3Department of Medicine, Division of Cardiology, Emory Program in Cardiovascular Outcomes Research and Epidemiology, Atlanta, Georgia;
- 4Christiana Care Health System, Newark, Delaware;
- 5Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia;
- 6Department of Medicine, Emory University School of Medicine, Atlanta, Georgia;
- 7Atlanta VA Medical Center, Decatur, Georgia.
- Corresponding author: Mary K. Rhee, mrhee{at}emory.edu.
Abstract
OBJECTIVE To determine the proportion of the American population who would merit metformin treatment, according to recent American Diabetes Association (ADA) consensus panel recommendations to prevent or delay the development of diabetes.
RESEARCH DESIGN AND METHODS Risk factors were evaluated in 1,581 Screening for Impaired Glucose Tolerance (SIGT), 2,014 Third National Health and Nutrition Examination Survey (NHANES III), and 1,111 National Health and Nutrition Examination Survey 2005–2006 (NHANES 2005–2006) subjects, who were non-Hispanic white and black, without known diabetes. Criteria for consideration of metformin included the presence of both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), with ≥1 additional diabetes risk factor: age <60 years, BMI ≥35 kg/m2, family history of diabetes, elevated triglycerides, reduced HDL cholesterol, hypertension, or A1C >6.0%.
RESULTS Isolated IFG, isolated IGT, and IFG and 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% of those with IFG and IGT; 31, 29, and 28% of all those with IFG; and 53, 57, and 62% of all those with IGT (8.1, 9.1, and 8.7% of all subjects), respectively.
CONCLUSIONS More than 96% of individuals with both IFG and IGT are likely to meet ADA consensus criteria for consideration of metformin. Because >28% of all those with IFG met the criteria, providers should perform oral glucose tolerance tests to find concomitant IGT in all patients with IFG. To the extent that our findings are representative of the U.S. population, ∼1 in 12 adults has a combination of pre-diabetes and risk factors that may justify consideration of metformin treatment for diabetes prevention.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received March 3, 2009.
- Accepted September 21, 2009.
- © 2010 by the American Diabetes Association.
