Evidence-based pharmacological investigation of the clinical practice and rational use of metformin in prediabetes mellitus

Prediabetes is a condition where blood glucose levels have deviated from the normal range but have not yet reached the diagnostic criteria for diabetes. It represents a transitional phase between health and diabetes. Currently, there are no global guidelines for managing prediabetes. However, the use of metformin in prediabetes is largely based on clinical experience, and there is a lack of high-quality evidence-based medicine. There are uncertainties regarding its dosage and unknown adverse reactions, and its exact efficacy and safety still require further study. This article systematically reviews the current state of metformin in the treatment of prediabetic, analyzing differences in efficacy across different dosages, the guideline recommendations, clinical application experiences, potential adverse effects and irrational drug use. We aim to provide scientific basis and clinical practice guidance for the rational use of metformin in the management of prediabetes.