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Prediabetes diabetes prevention — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CarePrediabetes diabetes preventionUSMLE Step 3

A 53-year-old woman with obesity and prediabetes returns after 6 months of lifestyle changes. Weight decreased by 3%, A1c remains 6.1%, and BMI is 36 kg/m2. She has a history of gestational diabetes and wants additional diabetes prevention options. Which of the following would you recommend at the follow-up visit?

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Correct answer: A — Discuss metformin for diabetes prevention along with intensive lifestyle intervention

Metformin can be considered for diabetes prevention in higher-risk prediabetes, especially with BMI at least 35 kg/m2, younger age, or prior gestational diabetes, alongside intensive lifestyle intervention.

Reference: ADA Standards of Care in Diabetes—2026