Written by Babatunde Carew
Spoon Feed
The MeMeMe study found that metformin significantly reduces the risk of diabetes in people with metabolic syndrome, while the Mediterranean diet had little added benefit on its own.
MeMeMe: Does metformin hit the high note?
Metabolic syndrome (MetS) affects over one-third of US adults and is well known to increase the risk of major adverse cardiac events (MACEs), type 2 diabetes, certain cancers, and all cause mortality. The Mediterranean diet (MedDiet) can reverse MetS, while metformin is known to prevent progression to metabolic syndrome in patients at risk.
The MeMeMe randomized trial assessed if metformin (1,700 mg/day) with or without a MedDiet intervention reduces noncommunicable disease incidence in MetS patients. Over three years, metformin alone and with MedDiet reduced type 2 diabetes incidence by 80% (HR 0.20, 95%CI 0.10–0.55) and 92% (HR 0.08, 0.02–0.35), respectively, compared to placebo. However, cardiovascular and cancer outcomes were unaffected. [AI-assisted]
The MedDiet alone was deemed to be ineffective in this population; however, adherence to the diet was poor, as evidenced by the study’s dietary index measure, and it was not paired with other lifestyle interventions like regular cardiovascular exercise.
How does this change my practice?
For my own patients with metabolic syndrome and impaired fasting glucose, often already on multiple medications, I weigh the benefits of adding metformin against the risks of polypharmacy and side effects. I emphasize shared decision-making, highlighting the potential to delay or avoid further medication through attempts at lifestyle changes like the MedDiet and regular exercise, and put the choice in the patient’s hands. This study does not change my current approach, as metformin’s effectiveness at reducing the incidence of T2DM is already well known. However, future studies exploring the effectiveness of medications like SGLT2is and GLP1as in this population may be practice-changing as they may have a more profound impact than metformin.
Source
Metformin Treatment With or Without Mediterranean Diet for the Prevention of Age-Related Diseases in People With Metabolic Syndrome: The MeMeMe Randomized Trial. Diabetes Care. 2024 Dec 6:dc241597. doi: 10.2337/dc24-1597. Epub ahead of print. PMID: 39641916
