Review demonstrates pharmacological prevention strategies for type 2 diabetes in obese individuals, highlighting the disease-modifying potential of incretin receptor agonists.
Key Points
Examine pharmacological strategies for preventing type 2 diabetes mellitus in individuals with prediabetes or obesity, focusing on incretin-based therapies.
Synthesized clinical evidence evaluating established and emerging glucose-lowering and antiobesity agents.
Assessed mechanism-specific actions and preventive indications across metformin, SGLT2 inhibitors, GLP-1 receptor agonists, and dual GIP/GLP-1 receptor agonists.
Metformin preserves the most established long-term evidence for diabetes prevention in high-risk prediabetes via hepatic and intestinal AMPK-dependent and independent pathways.
GLP-1 receptor agonists and the dual GIP/GLP-1 agonist tirzepatide induce clinically meaningful weight loss and cardiometabolic improvements that reduce diabetes risk.
SGLT2 inhibitors confer cardiovascular and renal benefits without adequate evidence for sole diabetes prevention, while next-generation triple incretin agonists remain under active investigation.