Why Isn’t Metformin Prescribed More?

Since its debut in the United States in 1995, metformin has become the most popular oral drug for Type 2 diabetes in the country — and the rest of the world. Current guidelines by the American Diabetes Association state that unless there are special risks in a particular person, metformin should be the first drug prescribed to people with Type 2 diabetes. Yet perhaps due in part to its popularity, metformin isn’t free of controversy. As we’ve discussed previously here at Diabetes Flashpoints, there are concerns about prescribing metformin in people with kidney disease, and some doctors even question whether metformin deserves its status as the universally recommended first-line drug for Type 2 diabetes. In addition, there’s debate about whether metformin should be taken by more people with prediabetes.

A recent study sought to explore the reasons why metformin isn’t prescribed as widely as clinical guidelines suggest it should be. Published last month in the journal Therapeutic Advances in Chronic Disease, the study notes that only roughly 65% of people with newly diagnosed Type 2 diabetes are prescribed metformin — and that over time, this number drops to just 25% of people with the condition. As noted in a Pharmacy Times article on the study, researchers from the University of Colorado put together focus groups of relevant people — doctors, pharmacists, and other medical personnel — to ask about their perceptions regarding metformin.

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Based on these focus groups, the researchers found that three main factors affected how doctors prescribed metformin: concerns about when to start the drug, concerns about the drug’s known risks, and whether procedures were in place to notice and deal with any adverse reactions caused by the drug.

Based on the focus groups’ responses, the researchers concluded that overall, perceptions about the risks of metformin weren’t based on the latest research and clinical recommendations — especially when it came to the risk of lactic acidosis (a very rare but serious side effect of metformin and certain other drugs), as well as how compatible the drug is with kidney disease, heart failure, liver disease, or alcohol use. When the latest evidence was discussed with members of the focus groups, some participants shared that their attitude toward prescribing metformin had changed. This led the researchers to conclude that certain education efforts — including distributing information, but also incorporating guidelines into tools for electronic prescribing — could lead more doctors to prescribe metformin to more patients, in accordance with clinical guidelines.

What’s your experience with metformin — do you take it, or have you taken it in the past? Is it the first drug that your doctor prescribed for your diabetes? If you no longer take it, why? Did you experience any unpleasant reactions or side effects from the drug? Do you think it’s important for doctors to follow clinical guidelines for prescribing drugs, or should they let their own experience be their guide? Leave a comment below!

  • T2DM

    Metformin can cause Vitamin B12 deficiency. Recently, Vitamin B12 deficiency has been linked with Alzheimers. The real question is why aren’t more physicians promoting eating reduced carbs, 130 g or less per day, to all their Type 2 patients? Full lipid panel, try less carbs, retest after 3 months and look at the triglycerides. That kind of visible success was very motivating for me.

  • Mumbro Oz

    I was on 3 x 1000mg of Metformin for over 5 years then was put on Januvia because of badly controlled T2D. I started LCHF Diet November 2015 and stop Januvia and Metformin within a couple of days and have had good control without medication ever since. I did not have any trouble whilst taking the medications other than I was always hungry and constantly battling to control appetite and weight gains. LCHF has dramatically improved my life and I believe my beta cell function.

  • Scott Beveridge

    I was taking Metformin for a few months when I was first diagnosed with Type 2. By changing my diet and exercise habits I was taken off Metformin and now take no diabetes medicine. Diet and exercise is key. While on Metformin I did not have any issues with the medicine.

  • Carrie Simmons

    I’ve got a roommate who was accuses of being a alcoholic ands has been on Metformin for 2008. He’s got a multitude of health problems since he’s been on it. He’s got 4 problems out of the problems. Advice is needed it’s not working well and his hospital visit he got MRSA and showed symptoms of damaged kidneys.

    • Angelique

      his alcoholism is the root problem it sounds like? he should not be drinking period and certaintly not when taking metformin.

  • Maris Smith

    I was prescribed Metformin for several years, and during that time, I became so weak it was difficult for me to walk a hundred feet. When I was first prescribed this drug, I honestly felt like I was dying. It made me feel sick and it made me have tunnel vision where my vision would become a pinpoint. I complained and they put me on extended release. My A1c never got under 8 taking this medication. So he prescribed insulin along with the Metformin. The outcome of that was I gained a huge amount of weight, and could not exercise with the insulin because the Metformin made me so weak. I finally refused to take it anymore, and told the doctor I would only take insulin injections. After about a year, my strength returned. I started on a diet and exercise program and have lost 90 pounds. No idea if anyone else had this experience, or these side effects. My A1c is close to 7, and my sugar levels are much easier to be controlled. Even my insulin use has gone down by 80 units a day because of the exercise and weight loss.

  • Shoshana

    Lowered body temperature.

  • azjen

    i was never prescribed with diabetes 2 & yet my doctor prescribed it & told me to take it. The pills gave me horrendous diarrhea & it was so bad that I simply had to quit taking it. Upon seeing my doctor again, I told her of what I had experienced & she said that she gave me the pills so that I could lose weight. Well, I never heard her say that nor did my husband. I am positive that I do not have diabetes 2. My glucose level has been below the normal level. I quit taking the Rx b/c I simply could not tolerate it anymore.

  • Popeye

    Used to have the same problem but it stopped when I went to metformin ER (extended release).

  • DesertAngel

    I was prescribed metformin after giving birth to my baby a couple of years ago. It’s helped with my blood sugar numbers, but I ended up in the hospital with an enlarged liver and lactic acidosis.

    The side effects were and continue to be awful! I have the runs at least 3 times a day…. and it’s difficult to go places because I just don’t know when I’ll have “to go” and how far it will take for me to get to the restroom.

    I want to get off of this medication. I’m taking 850mg twice a day. I can’t wait to see a specialist next week who will hopefully offer me a better med than this stuff. It’s scary!

    • Angelique

      that sounds really high. most people just take 500 a day. are you diabetic or prediabetic?

  • Aine

    Was prescribed as soon as I was diagnosed. After 2 weeks I asked the doctor to take me off it because it made me feel unwell. My trainer said I didn’t seem like I was there. I can’t be any more specific than that. I have been able to control my diabetes fine with diet and no meds. I would not take Metformin again.

    • Jaspen

      When my grandmother would take it, her stomach would start hurting and she would get nauseous. She was taken off of the medicine, and now her sugar is under control. Actually, she had higher blood sugar when she took the medicine than when she didn’t.

  • Peggy Bailey

    My husband has been taking Metformin for about 5 months. No side effects or feeling unwell. In fact his blood sugar is leveling out. Different results for different people.

  • Kathy Lowther

    I have been on Metformin for close to 13 yrs. now! As far as I know there have been no side effects bothering me!

    But I have experienced stomach problems lately that no one knows why! I get frequent leg cramps at night and some during the day! I have a sleeping problem now too! I will talk to my doctor again but probably with no help!

    • Swiftman

      I have been on Metformin for over 20 years. My Type ll is hereditary as I’m not overweight. My readings are 15 – 20% over normal, but continue to be contained. I am very happy with this medicine and do not have any side effects.

  • John Lovejoy

    I was diabetic and didn’t know it, even though I had checkups twice a year. For some reason, my doctor didn’t tell me even though my A1C was 8.9. My doctor left and was replaced by a new doctor, who happened to be on her last day before retiring. She told me I was diabetic and should get on insulin immediately. I couldn’t believe that prescription. Long story short, I met “doctor” #3 shortly afterwards, who put me on Metformin. I had been somewhat overweight but began losing two pounds a month. Ten months of weight loss put me 40 pounds lighter than I had been. And I felt great. I still do and my weight is holding steady. Blood panels and urine tests show that I am fine in that regard. So, to sum up, Metformin for me was a lifesaver. Haven’t felt this good for decades, and I’m 76. And my AIC is 5.8.

  • pastoredsmith

    I’ve taken metformin for 18 years, originally prescribed after a heart attack and with “borderline” diabetes type 2 at age 40 to help me lose weight. I was prescribed a double dose of (4) 500 mg tablets per day (2 in the AM and 2 in the PM) for “the foreseeable future.” Then, I was sent to a surgeon after a month of taking this med with pains in my lower abdomen and the symptoms for gall bladder attack. Exrays showed that I had “sludge” in the gallbladder and it was removed. No stones. The stated reason was that “metformin causes gallstones and as a precaution we’re removing your gallbladder.” For 18 years, and with each dose lasting four hours or longer, I have stomach pain….every day that passes. No doctor will consider taking me off it, even when my blood sugars are way down and A1C is under 6.7. I officially hate this medication! I also have a friend who died from complications caused by metformin (liver enzymes got high and he neglected to keep them checked due to a relocation and doctor change)….Did I mention that I hate metformin? Sometimes, I “forget” to take my morning meds so that I don’t have stomach cramps and pain during the AM…..

  • Lynnette

    I’ve been taking metformin 7 years now for type2 diabetes and i’ve never really noticed any side effects. Of course I was taking alot of medication through out the day for other issues that probably hid anything that might have come up….lol. I quit taking it 2-3 months ago (drs still aren’t aware) along with most of my other medications. I started losing weight while doing hoslpice care for my brother in June 2016. By the time he passed in September I had lost a good 40+ lbs and I hadn’t really changed much except I was living out of my suitcase and staying at the care center he was in so I went out to eat once a day (usually dinner) and I ate Yogurt and fruit for breakfast, then I snacked throughout the rest of the day and evening on fruit/nuts/chips. I didn’t really cut down on the amount of food I ate, I think it also involved me walking and running the facility halls tracking down nurses and staff to take care of my brother when the job was to much for me. He was 6’5″ and bulky from years of construction and I couldln’t lift him or roll him by myself. Anyway, after I lost another 30-40 lbs I decided I wanted to see if I still had type 2 diabetes, so I started testing and the numbers were always right where they should be, so I quit taking my meds. I still have low numbers and am taking no meds. So maybe just changing how many meals I cooked and ate for the snacking on more natural foods all day long helped. I encourage anyone with Pre-Diabetes or Type 2 to change your eating habits to little or no meat (or meat products), and eat naturally grown foods. You will see a huge difference….I have dropped over 80lbs and toned up and can fit in regular clothes again. It’s amazing what eating better can do for you, I didn’t it because I had no choice, imagine if you did it conciously what would happen 🙂

  • Ramo22

    I have been taking Metformin for the past 10 years and my problem is the stomach complications.sometimes my stomach is bloated or running or irritated, but if i go 2 days without taking it my stomach is fine. I have been telling the sisters at the clinic but they don do anything and I have decided to stop taking it and see what is going to happen.

  • MSSpahr

    I was started on Metformin for an A1C of 6.6. After about two weeks, I lost my appetite. This continued instead of wearing off as it should have done. By the time I returned to my doctor for another checkup, I had lost 10 lb. (I started out at 135) and could not afford to lose more. I had virtually no appetite morning, noon or night. I took myself off the Metformin and have been on no diabetes meds since. After nine months of no meds, my fasting blood sugars are normal, almost always under 100, and my A1C is 5.8. It’s like the Metformin pushed a reset button on my body. I feel great, my numbers are normal and I am not on a diabetic diet, I eat what I want and I have regained my weight. Maybe a short course of Metformin is curative for a handful of folks. I’m glad I took it.

  • Robyn Ward

    I had been on metformin for over 20 years with no effects obvious until late last year I needed a stent in my heart then again in april I needed another stent and also suffered badly with fluid on the lungs causing difficulty with breathing. Two weeks after being released from hospital I was rushed back into into hospital unable to get my breath and was diagnosed with pneumonia for which i was treated with strong antibiotics. After 4 days I was starting to feel a lot better but this was short lived as by the 6th day my breathing got much worse. My doctor in desperation to find the problem ordered a special blood test only to discover it was lactic acidosis from the metformin. Thankfully stopping metformin started showing great improvement immediately. This doctor was not an endocrinologist but a cardiologist and had seen this problem only once before.

  • Janice McNider

    I started Metformin 20 odd years ago, and was taking 6 tablets per day, I was in hospital on and off with urine problems for years until 2016 . This was different I was throwing up no matter what I ate or drank my blood sugar was very low and it just would not go up because of the sickness. I had a very bad Hypo and was admitted to Hospital where they discovered not only was my diabetes all over the place I had lost 3 stone in as many weeks but most of all Metformin along with a handful of other drugs for blood pressure, water retention, and another diabetic drug had damaged my Kidneys. I had a biopsy and both my Kidneys were badly damaged. Now I attend the Renal Clinic approx., every 6-8 weeks, and I have to change my diet to low salt and low potassium . I was diagnosed with diabetes 29 yrs ago at the age of 33yrs but was told It was possible that I had been diabetic for at least 4 years meaning I would be 29yrs old before that.I am now nearly 63. Metformin with a combo of other drugs gave me CKD. What Next? I think your Doctor knows you best and therefor should give you what you need and not what faceless people in big chairs sitting telling Doctors what they should give to everybody regardless. I by the way live in the UK.

  • P Aurora Robinson

    I have been taking Metformin for 10 years now due to a number of medical emergencies that rendered me more immobile than my body should have been, the heart issue won! To add insult to it all I was diagnosed with Crohns Disease a few years earlier and so the battle between weight gain and weight loss rages on. The pre-diabetes diagnosis has me perplexed and the Crohns makes matter even more perplexing. I take 500 mg daily of Metformin, and watch my diet constantly. I can not get rid of the fat around my middle regardless of the exercise I do.