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    The UK Prospective Diabetes Study, a large clinical trial performed in 1980-90s, provided evidence that metformin reduced the rate of adverse cardiovascular outcomes in overweight patients with type 2 diabetes relative to other antihyperglycemic agents. Treatment guidelines for major professional associations including the European Association for the Study of Diabetes, the European Society for Cardiology and the American Diabetes Association, now describe evidence for the cardiovascular benefits of metformin as equivocal. In 2017, the American College of Physicians's guidelines were updated to recognize metformin as the first-line treatment for type-2 diabetes. For example, a 2014 review found tentative evidence that people treated with sulfonylureas had a higher risk of severe low blood sugar events (RR 5.64), though their risk of non-fatal cardiovascular events was lower than the risk of those treated with metformin (RR 0.67). There was not enough data available at that time to determine the relative risk of death or of death from heart disease. study known as the Diabetes Prevention Program, participants were divided into groups and given either placebo, metformin, or lifestyle intervention and followed for an average of three years. Metformin treatment of people at a prediabetes stage of risk for type 2 diabetes may decrease their chances of developing the disease, although intensive physical exercise and dieting work significantly better for this purpose. The intensive program of lifestyle modifications included a 16-lesson training on dieting and exercise followed by monthly individualized sessions with the goals of decreasing weight by 7% and engaging in physical activity for at least 150 minutes per week. The incidence of diabetes was 58% lower in the lifestyle group and 31% lower in individuals given metformin. Among younger people with a higher body mass index, lifestyle modification was no more effective than metformin, and for older individuals with a lower body mass index, metformin was no better than placebo in preventing diabetes. This guide isn’t intended to be a source of “cut and paste” bullets for you to simply “check the block” on an evaluation. Instead, these examples are intended to get you, the Rater, to break your writer’s block and create unique bullets for your NCO. Bullets/Comments for Bullet comments for “FAIL” entries may include the reason(s) for failure and/or note any progress toward meeting physical fitness standards of AR 350–1. Rated NCO fails to meet or maintain the required Army standards and organizational goals of leader competencies and attributes; does not enforce or meet the standard for the unit or those in his/her charge; exhibits/displays minimal or no effort; actions often have a negative effect on the mission, their Soldiers, the unit, and the Army. 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