More Evidence for a Prevention-Related Indication for Metformin: Let the Arguments Resume!

Global estimates of the number of individuals with diabetes are staggering, and the prevalence is reported to be increasing in most countries. In 2017, it was estimated that approximately 425 million adults (20–79 years of age) were living with diabetes and that half were undiagnosed (1). This number with diabetes is projected to increase to 629 million individuals by 2045 (1). An overwhelming majority of cases are attributable to type 2 diabetes. In the U.S., the latest projections identify over 30 million Americans living with diabetes (2). The numbers at risk for developing diabetes are also of great concern. Worldwide, 352 million people are thought to be at risk, with 84 million of those individuals in the U.S. (1,2). The global diabetes burden imposes great personal costs to each individual and to society in general. Beyond the overall reduction of quality of life and productivity due to complications of diabetes, in 2017 diabetes was estimated to result in 4 million deaths worldwide (1). In addition, the International Diabetes Federation estimates that diabetes caused at least $727 billion (USD) in health expenditure in 2017—12% of total spending on adults (1). In the U.S., the estimated total costs of diagnosed diabetes have risen from $245 billion in 2012 to $327 billion in 2017, a 26% increase over a 5-year period (3). The growing personal burdens of diabetes are not acceptable given our research advances, and the costs of caring for diabetes are simply not sustainable! Thus, preventive strategies on a global scale remain a priority. Clinical studies have provided extensive and growing evidence for the efficacy of preventive strategies (4–8). There is convincing support for using lifestyle modification (focused on healthy eating, weight loss, and enhanced physical activity) as the cornerstone of preventive therapy. We are encouraged …