Metformin was less effective than
lifestyle modification in the DPP and
DPPOS but may be cost-saving over a
10-year period (10). It was as effective
as lifestyle modification in participants
with BMI $35 kg/m2 but not signifi-
cantly better than placebo in those
over 60 years of age (1). In the DPP, for
women with a history of GDM, metformin
and intensive lifestyle modification
led to an equivalent 50% reduction in
diabetes risk (13). Metformin may be
recommended for very high-risk individuals
(e.g., with history of GDM, who are very
obese, and/or those with more severe or
progressive hyperglycemia).