Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in the blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. It’s commonly prescribed to help with the treatment of Type-2 diabetes. Early research shows metformin reduces the odds prediabetes will progress to diabetes by about one-third. However, a number of studies are also asking for this to be reconsidered for a variety of the negative effects this can have on a patient.
Key Takeaways
Metformin, a common Type-2 diabetes medication, has shown to reduce diabetes risk in higher-risk individuals with prediabetes, particularly among those under 60, with higher BMI, history of gestational diabetes, and elevated A1C levels. Studies from the Diabetes Prevention Program (DPP) indicate a 31% reduction in diabetes progression, making metformin a potential preventive option for those at higher risk.
More recent studies suggest that metformin may not be necessary for all prediabetes cases. Many with prediabetes don’t develop diabetes, and some return to normal glucose levels without medication. Additionally, since prediabetes doesn’t carry the same risk of microvascular complications as diabetes, routine metformin use may offer limited benefit.
When considering metformin for prediabetes, personal risk factors like family history, age, BMI, and blood sugar levels are important. High-risk individuals may benefit from metformin, but it’s essential to consult with a healthcare provider to determine the best approach.
Metformin and Prediabetes
While research shows that metformin can be effective in the treatment of prediabetes, there are also more recent studies that indicate the microvascular complications of diabetes on a drug with no immediate advantage except to lower subdiabetes glycemia to even lower levels, is potentially not worth the use.
Early Research
Early research published in 2019 showed significant promises in metformin being effective at treating prediabetes.
The study concluded some of the following:
Metformin is effective in preventing diabetes for higher-risk groups, particularly overweight and obese individuals with prediabetes. The Diabetes Prevention Program (DPP) study found a 31% reduction in diabetes risk with metformin compared to a placebo. On average, 14 people need to take metformin for three years to prevent one case of diabetes.
The effective treatment in prediabetes can be highly beneficial to patients. Delaying diabetes can have several benefits:
Diabetes requires more frequent medical tests and monitoring, like eye and foot exams and blood pressure checks.
People with diabetes face higher risks of related complications and may experience stigma.
The study concluded that higher risk groups may be more inclined to want to explore metformin as a potential prediabetes treatment. Those higher risk groups would include those under 60, people with a BMI over 35, women with a history of gestational diabetes, and those with higher A1C levels (6.0%-6.4%). Factors like family history, high fasting glucose, and elevated triglycerides are all indicators of increased diabetes risk. Which may also be signals to seek prediabetes treatment.
In short, metformin did show strong promises and continues to do so. However, more recent studies have started to find some of the drawbacks of the medication and those with prediabetes.
More Recent Studies
More recent studies have been suggesting that metformin use should not be a prediabetes treatment. Mostly due to the increased risk of microvascular complications that it comes with. And the notion that the patient isn’t truly in a diabetic state.
The study concluded these reasons against routine metformin use for prediabetes:
Most people with prediabetes don’t develop diabetes: About two-thirds do not progress to diabetes, even over many years.
Some people naturally return to normal glucose levels: Around one-third of those with prediabetes go back to normal without medication.
Low risk of diabetes complications: People with prediabetes aren’t at risk for microvascular (small blood vessel) complications, so metformin wouldn’t help in this area.
As a result the study concluded that it’s best to only start metformin during its intended use, when a patient has been diagnosed with Type-2 diabetes.
Which Study to Follow
If you’re trying to treat prediabetes, it’s important to have some insights into your genetic history (i.e., family members who may have suffered from Type-2 diabetes in the past). Both studies indicate that those who are at higher risk may want to use metformin as a prediabetes treatment. Meaning, it’s important that you take a look at your overall health, family history, and factor that into your decision-making as a patient.
In the study published in 2020 by Dr. Mayer B. Davidson concluded, “Metformin should be reserved for those at the highest risk of diabetes—people with FPG levels of 110-125 mg/dL, A1C levels of 6.0-6.4%, or a history of gestational diabetes.”
Speak with your primary care physician about the opportunity to explore treatment of prediabetes if you’re concerned about your future health.
Metformin and Prediabetes Side Effects
Metformin and prediabetes patients typically suffer from the same common side effects as those who are taking metformin for the treatment of Type-2 diabetes. Those include:
Diarrhea
Headache
Stomachache
Bloating
Dizziness
Metallic taste in mouth
Racing heart
Shortness of breath
Heartburn
Fatigue and “tiredness”
Weight loss
Constipation
Gastrointestinal issues (gas)
Hypoglycemia
Lack of energy
Loss of appetite
Muscle pain
Nausea, vomiting, and heartburn
Weakness
Confusion
Lactic acidosis
Vitamin B12 deficiency
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Sources
Davidson MB. Metformin should not be used to treat prediabetes. Diabetes Care. 2020;43(12):2801-2806. doi:10.2337/dc19-2221. PMID: 32936780.
Should adults with prediabetes be prescribed metformin to prevent diabetes mellitus? Yes: high-quality evidence supports metformin use in persons at high risk. Am Fam Physician. 2019;100(3):134-135.
Nasri, H., & Rafieian-Kopaei, M. (2014). Metformin: Current knowledge. Journal of Research in Medical Sciences, 19(7), 658–664. PMCID: PMC4214027, PMID: 25364368.
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