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Author Notes:

Corresponding author: Mary K. Rhee, mrhee@emory.edu.

Parts of this study were presented in abstract form at the 68th Scientific Sessions of the American Diabetes Association, San Francisco, California, 6–10 June 2008.

We thank the other members of the SIGT research group: Jack Kaufman, Aisha Bobcombe, Rincy Varughese, Eileen Osinski, Jade Irving, Amy Barrera, Lennisha Pinckney, Jane Caudle, and Circe Tsui.

We also appreciate the support of the Emory General Clinical Research Center and its staff.

No potential conflicts of interest relevant to this article were reported.


Research Funding:

This work was supported in part by grants DK-070715 and RR-017643 (to M.K.R.), HS-07922 and DK-066204 (to L.S.P., W.S.W., P.K., and V.V.), VA HSR&D SHP 08-144 and IIR 07-138 (to L.S.P.), K24-HL-077506, K24-HL-077506, R01-HL-68630, and R01-AG-026255 (to V.V.), and RR-00039.

Many Americans Have Pre-Diabetes and Should Be Considered for Metformin Therapy


Journal Title:

Diabetes Care


Volume 33, Number 1


, Pages 49-54

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2010 by the American Diabetes Association.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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