Metformin and Dietary Restriction to Prevent Age-related Morbid Events in People With Metabolic Syndrome

Phase III randomized controlled trial on men and women with MetS to test the hypothesis that comprehensive life-style changes and/or metformin treatment prevent ArCD.

Design:

2x2 factorial: 2,000 volunteers will be randomized in four equal groups of 500 each, and allocated to the following treatments: METFORMIN (1700MG/DAY) + ACTIVE LIFESTYLE INTERVENTION PLACEBO + ACTIVE LIFESTYLE INTERVENTION METFORMIN (1700 mg/day) alone PLACEBO alone The metformin /placebo component of the study will be double blind.

Inclusion criteria

• Age 55-74, waist circumference equal or greater than 85 cm for women and 100 cm for men, plus at least two other factors among those defining the MetS

Exclusion criteria

• Diagnosed diabetes (or baseline fasting glycemia above 7mmol/L at baseline examination)
• Cancer (except skin carcinoma) diagnosed in the last 5 years, or under treatment
• Excessive frailty: in absence of agreed-upon measurements parameters and cutoff points, the investigator will exclude subjects under the lower 5th percentile of the muscular mass distribution estimated by impedance in previous studies
• Conditions that contraindicate the use of MET because might favour lactic acidosis:

• Renal, cardiac, hepatic, or respiratory insufficiency
• Serum creatinine <124μmol/L, or proteinuria at baseline examination
• Current treatment with K-sparing diuretics, or with proton pump inhibitors
• Excessive alcohol consumption
• Distressing side effects of MET treatment. Nausea and diarrhoea typically occur in about one third of patients receiving MET for the first time at full dose. To avoid dropouts for gastrointestinal discomfort we will treat all volunteers with half the planned dose for one month in order to exclude intolerant subjects before randomization. Participants randomized in the intervention group will continue to take half a dose for one month and then shift to the full dose.