When do you consider starting medications such as metformin or a GLP-1 RA for the purpose of DM prevention in patients whose A1c% is not in the diagnostic range but demonstrates progressive weight gain/metabolic dysfunction?

Realistically, starting a GLP-1 is almost entirely dependent on whether insurance covers the medication or not. Given that Medicare/Medicaid covers the medicine for diabetes, OSA, cardiovascular disease, or MASH, I find it is often difficult to get it covered solely for obesity unless they have certain private insurance. In terms of Metformin, it is worth considering Metformin in prediabetic patients as a means to mitigate DM progression or as an off-label anti-obesity medication since it is much cheaper and more often covered. We do know from the Diabetes Prevention Program studies that lifestyle-focused interventions are more effective than metformin at preventing progression to diabetes, but they can be synergistic in value and are espec...