Endocrinology-Diabetes Questions Prediabetes

Can prediabetes numbers be managed with just diet alterations?

My husband recently did his blood tests and they have indicated that he has prediabetes. The doctor has recommended diet and exercise to manage his condition, but is this the only way?

7 Answers

Diet (low carb, avoiding sweets, breads, juices) and exercise are still the most important things people with pre-diabetes can do to prevent, or postpone, becoming diabetic, and type 2 diabetics can do to prevent the progression of diabetes. By doing so, you are detoxifying your body of the sugars, and allowing it to burn off the sugars and metabolize them more efficiently instead of overwhelming it.
Lifestyle modification is the most effective way to manage prediabetes. Metformin has been used as an off-label treatment (not FDA approved for prediabetes), but it only lows risk of developing diabetes by 30%. Lifestyle modification will lower by 60% if done properly.
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Generally yes.
It is well known that metformin can help prevent diabetes.
The first line of treatment would be lifestyle change. The need to lose weight and avoid large amounts of carbohydrates and fine sugar at the meals. This classification was created to warn patients to lose weight to avoid developing diabetes.
Diet and exercise is the best way to manage pre-diabetes, but medications can also be helpful. The largest trial examining this was the "diabetes prevention and treatment trial." In this study (of >1000 individuals), diet and exercise reduced risk of progression to type 2 diabetes by 58% vs the medication metformin which reduced risk of progression to diabetes by 31% over 5 years. Bottom line is, treatment of pre-diabetes significantly reduces risk of progressing to type 2 diabetes and lifestyle therapies have a greater magnitude of effect (vs medication). I recommend that your husband follow his doctor's advise for managing pre-diabetes with diet and exercise, but medication could also be considered.
It is not the only way but is the best way. Even if certain meds are used, he still needs to practice good diet and exercise. Metformin has been used in people with prediabetes with some success is slowing the development & progression. It is the cheapest drug but probably not the best one. There have been studies of the glitazone class of drugs, especially piaglitazone (Actose) & it has demonstrated a prevention effect. The other class of drugs being tested for this purpose are the GLP1-RA. This class includes drugs like Byetta, Victoza, Trullicity, and about 1/2 a dozen others. These drugs have multiple effects on several of the defects that lead to diabetes. Their disadvantage is they cause nausea, diarrhea & bloating if not used carefully. They also have to be taken by injection though the long acting ones can be taken only once a week. They are working on an oral form of these drugs. But don't forget the diet & exercise. A study done several years ago on people with pre-diabetes showed that metformin without diet and exercise slowed the development of diabetes over 5 yrs by 30% over controls who got no treatment. That sounds good but there is more. The people who did diet and exercise with NO medicines had a 60% reduction over controls. So what ever you do in the way of medications-DON'T Forget DIET & EXERCISE.