Drug therapy for prediabetic metabolic syndrome patients?

http://www.ncbi.nlm.nih.gov/pubmed/21207204

Curr Diab Rep. 2011 Jan 5. [Epub ahead of print]
Should the Metabolic Syndrome Patient with Prediabetes Be Offered Pharmacotherapy?
Sullivan SD, Ratner RE.

Department of Endocrinology, Washington Hospital Center, 110 Irving Street, NW, Suite 2A-72, Washington, DC, 20010, USA, Shannon.d.sullivan@medstar.net.
Abstract
Impaired fasting glucose and impaired glucose tolerance reflect perturbations in glucose metabolism and define a prediabetic state in which risk for type 2 diabetes mellitus (T2DM) is increased. There is overlap between prediabetes and the metabolic syndrome, which itself increases the risk for T2DM and cardiovascular disease. The utility of medical interventions to prevent progression to diabetes in prediabetic individuals, many of whom also manifest metabolic syndrome, has been examined in several large clinical trials. Intensive lifestyle intervention consistently results in drastic reductions in the incidence of T2DM and reversal of metabolic syndrome. Additionally, pharmacotherapies-including metformin, acarbose, thiazolidinediones, glucagon-like peptide 1 receptor agonists, and renin-angiotensin inhibitors-also reduce diabetes incidence with variable effects on metabolic syndrome components. Taken together, we recommend that prediabetic patients undergo intensive lifestyle intervention, with the addition of pharmacotherapy based on the presence of specific features of the metabolic syndrome, for diabetes prevention.