OBJECTIVE: The Metformin and Dietary Restriction to Prevent Age-Related Morbid Events in People With Metabolic Syndrome (MeMeMe) trial tested whether 1,700 mg/day metformin (MET) with or without a Mediterranean diet (MedDiet) intervention could reduce the cumulative incidence of major noncommunicable diseases in people with metabolic syndrome.
RESEARCH DESIGN AND METHODS: A total of 1,442 participants were randomly assigned to one of four interventions: 1) MET (1,700 mg/day) plus MedDiet intervention (MET+MedDiet); 2) placebo plus MedDiet intervention; 3) MET (1,700 mg/day) alone; and 4) placebo alone. Participants were followed up for 3 years on average. The primary outcome was the cumulative incidence of major noncommunicable diseases (including type 2 diabetes, cardiovascular diseases, and cancer). Secondary outcomes were the incidence of type 2 diabetes and the changing prevalence of metabolic syndrome.
RESULTS: The crude incidence of the major noncommunicable diseases was 6.7 cases per 100 person-years in the MET+MedDiet group, 6.9 in the MET alone group, 13.3 in the placebo plus MedDiet group, and 11.3 in the placebo group. The differences were fully explained by the reduction of type 2 diabetes, which was 80% and 92% lower in the MET and MET+MedDiet groups, respectively, compared with placebo.
CONCLUSIONS: The use of 1,700 mg/day MET is effective to prevent diabetes in people selected on the basis of metabolic syndrome.
| Discipline Area | Score |
|---|---|
| Public Health |  |
| Special Interest - Obesity -- Physician |  |
| Family Medicine (FM)/General Practice (GP) |  |
| General Internal Medicine-Primary Care(US) | |
| Endocrine |  |
This study supports using metformin to prevent diabetes from developing in patients with metabolic syndrome.
This is a carefully conducted five-year trial comparing placebo, metformin alone, diet alone, and metformin plus diet in patients with metabolic syndrome. The outcomes were occurrence of chronic diseases such as type 2 diabetes, cancer, and cardiovascular diseases. Diet alone was ineffective perhaps due to the lack of aggressiveness of the intervention, but the two groups on metformin had an 80-92% reduction in occurrence of diabetes. This is not a surprising finding (e.g., DPP trial NEJM 2002; 346:393-403). Although cancer and cardiovascular disease were not reduced in the treatment groups, these diagnoses were made based upon medical records and conceivably additional study time might be required.
This is a burgeoning topic of interest: namely, should we put people without a diagnosis of diabetes on metformin to prevent the progression to diabetes. This adds to the evidence; however, I wish they had tested a lower dose of metformin. 1700 mg a day is a lot of metformin.
Further confirmation that metformin "prevents" diabetes. The effect is small and it only prevents people from crossing an artificial dichotomous blood sugar line.
Excellent study. The results were shown in a visually striking manner.
