Date of Award

Spring 2023

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

McHugo, Jeannie

Abstract

Prediabetes is a common disease among American adults that is the predecessor to type 2 diabetes (T2D). T2D is a serious disease that causes long term damage to the heart, blood vessels, and kidneys if uncontrolled. This literature review looks at the effectiveness of medication (metformin), diet alone, exercise alone, and diet and exercise in combination in preventing the progression from prediabetes to a diagnosis of T2D. The literature review was performed using an electronic search database to identify literature related to preventing the conversion of prediabetes to T2D using either lifestyle modifications or metformin within the past five years. The research shows that both metformin and lifestyle modification have been effective in reducing the risk of prediabetes progressing to T2D. Lifestyle modification demonstrates improved ability to prevent progression from prediabetes to T2D in the short term versus the use of metformin. The combination of diet and exercise is likely superior to either used alone. This is important in the role of primary care practitioners educating their patients about the diagnoses of prediabetes and the benefits of making healthy lifestyle changes early on for their future health. While lifestyle modifications appear to show greater benefit in the short term, their impact has shown to be less effective when studied in the long term. Results from long term studies demonstrate that people are less likely to adhere to lifestyle modifications over time and more likely to adhere to the use of medication, such as metformin. When discussing primary care and treatment of prediabetes, it is imperative that providers and patients collaborate to come to an appropriate and realistic plan in preventing development of T2D. There has been benefit shown from all of the treatment options listed above and all come with their own risks and benefits, so it is important to treat each patient individually based on their wishes as well as what is likely to be the most realistic and beneficial treatment choice for that patient. Primary care providers can also help determine at what point pharmacological intervention is needed if lifestyle modification is not fulfilling the needs of the patient. When looking at longevity of treatment, more research needs to be completed regarding adherence to the different treatment options provided as well as their long-term efficacy.

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