Prevention of Progression of Prediabetes, Obesity and CV Risk

Inclusion Criteria:

1. Patients will have an established diagnosis of pre-Diabetes Mellitus (DM) before thescreening visit, documented by an acceptable modality in the last 6 months.

2. Age ≥ 18 years old

3. Body Mass Index (BMI)=25-40 kg/m2

4. Glycated Hemoglobin (HbA1c) = 5.7-6.4%

5. Blood Pressure (BP) <160/100

6. Estimated Glomerular Filtration Rate (eGFR) ≥30 ml/min•1.73m2

7. Body weight must be stable (±5 pounds) over the last 3 months.

8. Oral diuretics, if prescribed to the patient according to local guidelines anddiscretion of the investigator, should be stable for at least 1 week prior torandomization.

9. Hispanic ethic group

10. Willing to adhere to medication regimen for up to 6 months.

11. Male or female, if female, met these criteria:

12. Not pregnant or breast-feeding

13. Negative pregnancy test result at visit 1 (screening)

14. During the entire study, women of childbearing potential (WOCBP) includingperi-menopausal women who have a menstrual period within 1 year must practiceappropriate, and effective birth control, either implants or pills, or avasectomized partner prior to receiving the first dose of study medication

15. Does not suffer from severe claustrophobia

16. No contraindication for Magnetic Resonance Imaging (MRI) (metal plates, screws,shrapnel, pins, or cardiac pacemaker)

Exclusion Criteria:

1. Patients currently on one of the selected therapies

2. Extended diagnoses with Type 2 Diabetes

3. Pregnancy, lactation, women of childbearing age (WOCBA) unwilling to usecontraception

4. Known allergy/sensitivity to study drugs or their ingredients

5. Major oncologic diagnosis in the last 5 years

6. Current drug or alcohol use or dependence that, in the opinion of the siteinvestigator, would interfere with adherence to study requirements

7. Inability or unwillingness of individual or legal guardian/representative to givewritten informed consent

8. Major organ or metabolic diseases, or physical limitations that will not allow thesubject to complete the study

9. Myocardial infraction, coronary artery bypass graft surgery, or other majorcardiovascular event in the past 60 days

10. Heart transplant recipient or listed for a heart transplant

11. Currently implanted left ventricular assist device

12. Cardiomyopathy based on infiltrative or cumulative hypertrophic obstructivecardiomyopathy or known pericardial constriction

13. Any severe (obstructive or regurgitant) valvular heart disease, expected to lead tosurgery during the trial period

14. Acute decompensated heart failure requiring intravenous diuretics, vasodilators,inotropic agents, or mechanical support within 1 week of screening and during thescreening period prior to randomization

15. Implanted cardioverter defibrillator within 3 months prior to screening

16. Cardiac resynchronization therapy