However, a significant regression to normoglycemia was observed in participants taking ramipril, which suggests that ACE inhibitors may have a modest favorable effect on glucose metabolism. Routine use of ACE inhibitors for the express purpose of preventing diabetes isn’t indicated at this time.
Recommendations
The American Diabetes Association’s (ADA) 2009 position statement recommends starting treatment for IGT or IFG with intensive lifestyle modifications, including referral to an effective ongoing support program for loss of 5% to 10% of body weight and increasing exercise to at least 150 minutes a week of moderate aerobic activity (50%-70% of maximum heart rate).8 Follow-up counseling is important for success.
Metformin can be considered in addition to lifestyle interventions for patients at high risk for progression to diabetes, defined as:
- both IGT and IFG plus 1 other risk factor, such as hemoglobin A1C >6%, hypertension, low levels of high-density lipoprotein, elevated triglycerides, or diabetes in a first-degree relative
- obesity
- <60 years of age.
The ADA recommends against using other drugs for diabetes prevention because of issues of cost, side effects, and failure to produce a persistent pharmacologic effect. Patients with prediabetes should be monitored annually for progression to diabetes, using either fasting glucose or a 2-hour oral glucose tolerance test.