Metformin and Digital Lifestyle Intervention (Noom) for the Prevention of Diabetes in Childhood Cancer Survivors with Prediabetes, PREDM Study

Inclusion Criteria

• Participant in St. Jude Lifetime Cohort Study (SJLIFE) or a patient in the after completion of therapy (ACT) clinic and >= 5 years from diagnosis and at least 2 years from completion of therapy for childhood cancer
• >= 18 and < 45 years of age
• Prediabetic: fasting plasma glucose 105-125 mg/dL, hemoglobin A1c 5.7- 6.4% (either or both criteria may be present)
• According to institutional and National Institute of Health (NIH) policy, the study will accession research participants regardless of sex and ethnic background. Institutional experience confirms broad representation in this regard

Exclusion Criteria

• Absence of treatment related diabetes risk. Survivors will be excluded if their cancer treatment required observation only, surgery alone not involving the abdomen or brain, radiation alone not involving the chest (pancreatic risk), abdomen or brain (e.g. retinoblastoma treated with enucleation alone, melanoma of an extremity treated with excision alone, neuroblastoma in an infant requiring observation only)
• Diabetes at baseline assessment: fasting plasma glucose (FPG) >= 126 mg/dL, hemoglobin (Hb)A1c >= 6.5% or previous diagnosis by a physician (except gestational diabetes that resolved post-partum)
• Body mass index (BMI) < 19 kg/m^2
• Current metformin use (including for any period >= 30 days in the past 1 year [yr])
• Known allergy to metformin
• Current use of other oral glucose lowering medications, non-insulin injectable diabetes medications or insulin
• Current participation in a lifestyle change program
• Chronic kidney disease >= stage IIIb (estimated glomerular filtration rate [eGFR] < 45 mL/min)
• Severe cardiovascular disease or recent intervention (New York Heart Association [NYHA] class >= 2 or heart failure hospitalization in the past 6 months [mo], aortic stenosis, heart block including left bundle branch block [LBBB] or 3rd degree atrioventricular [AV] block, systolic blood pressure [SBP] > 180 or diastolic blood pressure [DBP] > 105 mmHg, myocardial infarction or coronary revascularization in the past 1 month)
• Severe hepatic dysfunction: cirrhosis or aspartate aminotransferase [AST]/alanine aminotransferase [ALT] > 3 times upper limit of normal
• Pulmonary disease with dependence on oxygen or daily use of bronchodilators
• Weight loss > 10% in the past 6 months
• Bariatric surgery in the past 2 years
• Pregnant, within 3 months post-partum, nursing, planning to become pregnant, or sire a child
• Anemia: hematocrit < 36% in males or < 33% in females
• Ongoing alcohol or substance abuse using criteria from the Alcohol Use Disorder Identification Test (AUDIT) and Drug Abuse Screening Test (DAST) questionnaires
• Diagnosis of schizophrenia or other psychotic disorder
• Vision impairment limiting ability to interface with the digital program
• Unable to swallow medication
• Non-English speaking
• Cognitive impairment defined by intelligence quotient (IQ) < 80 and/or per primary investigator (PI) discretion
• Current active cancer or undergoing treatment for active cancer
• No access to electronic device compatible with the digital lifestyle change platform