title: Many Americans have pre-diabetes and should be considered for metformin therapy.
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.
  
  
  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 > or =1 additional diabetes risk factor: age <60 years, BMI > or =35 kg/m(2), 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, approximately 1 in 12 adults has a combination of pre-diabetes and risk factors that may justify consideration of metformin treatment for diabetes prevention.
authors.affiliation: Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia, USA. mrhee@emory.edu
authors.forename: Mary K
authors.initials: MK
authors.lastname: Rhee
authors.forename: Kirsten
authors.initials: K
authors.lastname: Herrick
authors.forename: David C
authors.initials: DC
authors.lastname: Ziemer
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.forename: Paul
authors.initials: P
authors.lastname: Kolm
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Twombly
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
mesh_terms: D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000517:prevention & control; D005260:Female; D018149:Glucose Intolerance / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D011236:Prediabetic State / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin