Recommendations

l  Refer adults with overweight/obesity at high risk of type 2 diabetes, to an intensive lifestyle behavior change program for a weight reduction of at least 7% of initial body weight through a healthy reduced-calorie diet and 150 min/week of moderate-intensity physical activity. (Strong recommendation).

l  A variety of eating patterns should be considered to prevent diabetes in individuals with prediabetes. Including Mediterranean diet, low carbohydrate eating plan, low fat, DASH diet (Dietary approaches to stop hypertension) (Strong recommendation)

l  Prescribe metformin for prevention of T2DM in adult individuals with prediabetes, 25-59 years, those with high BMI ≥35 kg/m2, higher fasting plasma glucose 100 - 125 mg/dL, higher HbA1C 5.7 – 6.4%, women with prior GDM   (strong recommendation)

l  Prediabetes is associated with heightened cardiovascular risk; therefore, screening for and treatment of modifiable risk factors for cardiovascular disease should be considered. (Strong recommendation)

l  More intensive preventive approaches should be considered in individuals who are at particularly high risk of progression to diabetes, including individuals with BMI ≥35 kg/m2, those at higher glucose levels (e.g., fasting plasma glucose 100 –125 mg/dL, 2-h postprandial glucose 140 – 199 mg/dL, A1C 5.7 – 6.4%), and individuals with a history of gestational diabetes mellitus (strong recommendation)

l  Pharmacotherapy should be considered to achieve sustained weight loss, minimize the progression of hyperglycemia, and cardiovascular risk reduction. (strong recommendation)