Which patients with metabolic syndrome benefit from metformin?
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Q Which patients with metabolic syndrome benefit from metformin? Evidence-based answer: Patients at highest risk for progression to diabetes benefit from metformin. In patients with metabolic syndrome who are in the highest-risk quartile for progression to diabetes (predicted mean 3-year risk, 60%), metformin, 850 mg twice daily, reduces the absolute risk by about 20% over a 3-year period. Metformin doesn't reduce the incidence in patients at lower risk of progression (strength of recommendation [SOR]: C, post-hoc analysis of a randomized controlled trial [RCT]). Intensive lifestyle modification reduces absolute risk in all patients proportionate to risk quartile (from 5% reduction for the lowest quartile to 28% for the highest). Over a 10-year period, intensive lifestyle modification reduces the absolute risk of diabetes by 34% and metformin reduces the risk by 18% for all patients at increased risk (considered as a group) -- that is, not separated by risk quartile (SOR: A, large prospective RCTs). Lower doses or shorter courses of metformin reduce fasting plasma glucose (SOR: C, RCTs with laboratory outcomes) and may reduce the risk of developing diabetes by a smaller amount (SOR: C, flawed RCT).
Journal of Family Practice, 65(11) 2016: 832-834.