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I read with great interest the two articles with regard to this timely subject. And as is often the case, the truth sits between the two opposing points of view. As we have come to understand, hyperinsulinemia is rampant as the causal factor for type two diabetes, metabolic syndrome, perhaps metabolic fatty liver disease, PCOS and acanthosis nigricans just to name what comes to mind quickly. The causes of hyperinsulinemia are obesity and genetics both causing insulin resistance. The issue is the percentage of individuals with A1C values between 5.7%-6.4% who evolve into true diabetes as defined by an A1C above 6.4%. It has been proven that “treating” prediabetes with metformin among other medications does not generally affect the transition to true type 2 diabetes. Much as with “prehypertension”, another category open for debate, the concept of “prediabetes” provides a marker that can and perhaps should provoke better attention to preventative medicine and risk factor analysis, a role for which we as family medicine providers, are ideally suited. Jonathan R. Dreazen, MD