Metformin, as described by Johns Hopkins University, is “a commonly recommended initial medication for patients with type 2 diabetes who have mild to moderately uncontrolled blood glucose.” The university adds that for some of the 115 million Americans who are prediabetic, metformin is also sometimes prescribed to prevent the onset of type 2, though it’s not officially FDA-approved for this.
As Johns Hopkins notes, metformin is an “initial” treatment, meaning other interventions are sometimes added once it’s been tried. That’s when things like GLP-1 medication might be explored.
Offering alternative perspective, a team of 12 doctors from institutions like Albert Einstein College of Medicine in New York City, the University of Colorado, University of Pittsburgh School of Medicine, and the National Institute on Aging collaborated to uncover a new finding published June 2026 in the Journal of the American Medical Association. The doctors specialized in areas like endocrinology and metabolism, geriatrics, internal medicine, and more.
They observed data from 1,173 prediabetic participants who’d been Medicare recipients when they consented to have their health data tracked and analyzed, starting as far back as 1996 and moving through 2021.
Dividing the participants into three groups (intensive lifestyle intervention, metformin, or placebo), the researchers compared “multimorbidity” rates—that is, individuals who, in addition to their prediabetic status, were managing at least two other chronic health issues out of 15 the team measured. In their abstract, the researchers don’t name these conditions, but HealthDay does, listing “heart disease, kidney disease, cancer, arthritis and dementia.”
The “lifestyle” group underwent healthy changes to both diet and exercise.
Portrait of mid adult man on exercise bike at gym
Based on their analysis, the team found that 87% of the placebo group experienced multimorbidity, 85% of the metformin group did, and 82% of the lifestyle group did. HealthDay helps articulate the significance: “Over 21 years of follow-up, people in the lifestyle group were about 20% less likely to develop multiple chronic diseases compared to those in the placebo group.”
The study’s abstract also confirms that there was “no difference” between participants in the metformin and placebo groups.
This research offers more evidence related to the power of a balanced diet, and movement—which is a major influence in how major organs in the digestive system, like the pancreas and liver, process food for the body to use as fuel.
The Cleveland Clinic offers specific recommendations related to diet and exercise for reversing prediabetes:
Regular activity: Movement and exercise make your body more sensitive to insulin. Exercise also builds muscle that can absorb blood glucose. Aim for 30 minutes a day, five days a week, for a total of 150 minutes a week.
Eating changes: Try to cut out added sugars, swap simple carbs for complex carbs and eat more veggies. A dietitian can help you plan healthy eating patterns you can stick with long-term.
The Clinic adds that consistent research shows dropping body weight by 7%—that’s 14 pounds for a 200-pound individual—”can reduce the onset of [type 2 diabetes] by more than half.”
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