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.


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!