Date of Award

Spring 5-2025

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Staveteig, Mindy

Keywords

prediabetes, metformin, impaired fasting glucose, cardiovascular disease, diet, exercise, lifestyle modification, patient care

Abstract

Around 86 million people in the United States are diagnosed with prediabetes, a metabolic syndrome characterized by insulin resistance and inflammation. The inflammatory nature of the disease increases a patient's cardiovascular risk. Common treatment options include metformin and lifestyle intervention – primarily exercise and diet plans. However, there is no standard medical recommendation for lowering cardiovascular risk. The purpose of this literature review is to determine which treatment options, including the combination of lifestyle and intervention, best lower cardiovascular risk and better detail the effect of prediabetes on cardiovascular risk. Electronic databases PubMed and Embase were utilized and 12 studies were included in this review. Studies were randomized controlled trials, observational studies, or comparative studies published after 2018. Current research provides data showing that prediabetes increases the risk of hypertension and mortality from a cardiovascular event. One study showed that reversal from prediabetes to normoglycemia lowered risk of cardiovascular event by almost 50%. Research also showed that the best method for lowering cardiovascular risk was lifestyle intervention, while metformin was found to lower the effects of lifestyle intervention when studying the combination of the two. Future research could determine the best course of treatment for patients who are not able to complete lifestyle intervention goals, such as patients who are bedridden or frail. Gaining a better understanding of the interaction between metformin and lifestyle intervention will serve invaluable for the future of prediabetes treatment. This research should aid in provider treatment recommendations for patients with prediabetes and better detail a “standard” of care.

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