You can find below ADA recommendations on type 2 diabetes prevention. Weight loss, exercise and metformin are key. Cardiovascular risk factors need to be identified and addressed.
High risk for type 2 diabetes includes people with A1C 5.7–6.4%, impaired glucose tolerance, or impaired fasting glucose: ideal candidates for diabetes prevention efforts.
At least annual monitoring for the development of diabetes in those with prediabetes is suggested.
Patients with prediabetes should be referred to an intensive behavioral lifestyle intervention program modeled on the Diabetes Prevention Program to achieve and maintain 7% loss of initial body weight and increase moderate-intensity physical activity (such as brisk walking) to at least 150 min/week.
Metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially for those with BMI ≥35, those aged <60 years, women with prior gestational diabetes, and/or those with rising A1C despite lifestyle intervention.
Long-term use of metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy.
Pharmacologic agents including metformin, α-glucosidase inhibitors, orlistat, glucagon-like peptide 1 (GLP-1) receptor agonists, and thiazolidinediones have each been shown to decrease incident diabetes to various degrees in those with prediabetes. Metformin has the strongest evidence base and demonstrated long-term safety as pharmacologic therapy for diabetes prevention. For other drugs, cost, side effects, and durable efficacy require consideration.
Screening for and treatment of modifiable risk factors for cardiovascular disease is suggested for those with prediabetes.
People with prediabetes often have other cardiovascular risk factors, including hypertension and dyslipidemia, and are at increased risk for cardiovascular disease. Although treatment goals for people with prediabetes are the same as for the general population, increased vigilance is warranted to identify and treat these and other cardiovascular risk factors (e.g., smoking).