INS and Hyperglycemia: Recommendation 10: Consider hyperglycemia prophylaxis with metformin for patients at elevated risk (i.e., HbA1c ≥ 5.7%, prediabetes, BMI ≥ 30 kg/m2, elevated baseline FG); start metformin or escalate existing dose and add other agents to treat hyperglycemia, as needed, while avoiding insulin secretagogues, which can cause hypoglycemia.