Prediabetes Clinical Trial
Official title:
Metabolic Alterations in Platelet Study II
Diabetes mellitus (DM) imposes an approximate 2-fold increased risk of atherothrombosis.
Patients with type 2 DM have a 2- to 4-fold increase in the risk of coronary artery disease
(CAD) and atherothrombotic complications. Current evidence indicates that altered platelet
function and "reactivity" are key determinants of arterial and venous thrombosis in
metabolic syndromes. In addition, venous thrombosis and pulmonary embolism are associated
with increased body mass index, a common feature of type 2 DM and the metabolic syndrome.
Altered platelet behavior, function, and phenotype may be critical factors in these
thrombotic complications as well. The mechanisms that lead to altered phenotype and function
of platelets in DM, and that underlie heightened contributions of platelets to thrombotic
complications in type 2 DM, are nevertheless incompletely understood. In this project, the
investigators will prospectively determine if clinical intervention with metformin--a
commonly-used therapeutic agent that reduces blood glucose, promotes weight loss, and
improves lipid profiles--reverses platelet reprogramming and hyperreactivity in obese
subjects with impaired fasting glucose and thus, at-risk for type 2 DM.
In addition to metformin, all participants will be given lifestyle modification (LSM)
education on diet and physical activity, followed by guidance on how to adhere to the LSM,
depending on random assignment to intervention group (education only (n=26) vs.
implementation intentions alone (n=27) vs. implementation intentions with partner (n=27)).
The LSM coaching for different intervention groups will allow the investigators to test
whether there are more effective ways for adherence than others. Participants in these three
LSM intervention groups will be further randomized to either Metformin (n=40) or Placebo
(n=40), such that participants in the three LSM groups will be randomly and evenly
distributed across the two study medication groups.
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