Many suggest that people with prediabetes should take Metformin to prevent or delay type 2 diabetes. This has become a common treatment. However, there are also reasons not to treat with Metformin. First, two-thirds of people with pre-diabetes do not develop diabetes, even after many years. Second, about one-third of people with pre-diabetes return to normal blood sugar levels. Third, people with pre-diabetes are not at risk for eye and nerve complications (called microvascular complications) of diabetes; this means that Metformin will not affect this important outcome. Rather, people at the highest risk for developing diabetes, including those with blood sugar levels before breakfast of 110-125 mg/dL or HbA1c levels of 6.0–6.4%, or women with previous diabetes during pregnancy should be monitored closely. Some suggest that Metformin should only be used once diabetes is diagnosed. Others argue that Metformin should be used to prevent type 2 diabetes and complications, as risk for complications increases the longer someone lives with high blood sugar levels. Metformin has been around for a long time, is inexpensive, and relatively safe. However, there is debate about if it should be used to treat prediabetes.

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