Key result
Adding metformin to lifestyle intervention boosts prediabetes remission ~39% vs. lifestyle alone.
Why the study?
Does metformin plus lifestyle intervention improve prediabetes remission in adults with impaired glucose regulation?
RCT (n=1,678)
unblinded
block randomisation stratified by glucose status, presence of hypertension and use of anti-hypertensive medication
Yes
Does metformin plus lifestyle intervention improve prediabetes remission in adults with impaired glucose regulation?
Hazard Ratio: 1.39 (95% CI 1.16–1.67)
Absolute Event Rate: 31.5% vs 25.1%
p-value: p=< 0.001
Adding metformin to lifestyle intervention significantly increases the rate of prediabetes remission compared to lifestyle intervention alone in Chinese adults with impaired glucose regulation.
AIMS: Prediabetes affects 35% of Chinese adults and is associated with increased risks of cardiovascular disease and mortality. However, findings are inconsistent on the effects of lifestyle and pharmacological interventions in the prediabetes population achieving remission. This analysis aimed to compare the effects of metformin plus lifestyle intervention versus lifestyle intervention alone for prediabetes remission. MATERIALS AND METHODS: This was a secondary analysis of the China Diabetes Prevention Program (CDPP), a multicentre unblinded randomised controlled trial of 1678 participants aged 18-70 years with impaired glucose regulation from 43 hospitals across China (NCT03441750). Participants were randomly assigned (1:1) using block randomisation stratified by glucose status (impaired fasting glucose or impaired glucose tolerance), presence of hypertension and use of anti-hypertensive medication. They received either metformin plus lifestyle intervention or lifestyle intervention alone for 2 years. The primary outcome was prediabetes remission rate. RESULTS: During a median follow-up of 2.03 years, remission was achieved in 262/831 (31.5%) (138/396 men; 124/435 women) participants in the metformin plus lifestyle group versus 213/847 (25.1%) (106/397 men; 107/450 women) in the lifestyle alone group, with similar effects across subgroups. After adjusting for baseline characteristics, addition of metformin increased the rate of remission (HR 1.39, 95% CI 1.16-1.67, p < 0.001). Higher baseline HbA1c was associated with lower remission rates (HR 0.23, 95% CI 0.18-0.29, p < 0.001). CONCLUSIONS: Adding metformin to a lifestyle intervention significantly improved prediabetes remission rates over lifestyle intervention alone in Chinese adults with impaired glucose regulation. This may be an effective approach for prediabetes management.
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He et al. (2026) conducted an RCT in impaired glucose regulation (prediabetes) (n=1,678). Metformin plus lifestyle intervention vs. Lifestyle intervention alone was evaluated on prediabetes remission rate (HR 1.39, 95% CI 1.16-1.67, p=< 0.001). Adding metformin to a lifestyle intervention significantly increased the rate of prediabetes remission compared with lifestyle intervention alone (31.5% vs 25.1%; HR 1.39, 95% CI 1.16-1.67; p<0.001).
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