Should You Take Metformin?
Reviewed by CDE Mehandi Sharma · Updated
Metformin is sometimes offered in prediabetes, and the honest framing is that it works, less well than lifestyle change, and does not replace it.
The numbers. In the Diabetes Prevention Program, metformin reduced progression to diabetes by 31%, against 58% for intensive lifestyle intervention. In the Indian Diabetes Prevention Programme, metformin gave a 26.4% relative risk reduction against 28.5% for lifestyle — roughly equivalent there — and a 25% reduction at a low dose of 250 mg twice daily.
So lifestyle change was at least as good in Indians and clearly better in the American trial. Combining both added nothing beyond either alone in the Indian study.
Who it tends to be considered for: people at higher risk — younger people with higher HbA1c, those with a history of gestational diabetes, or those who have not managed to change progression through lifestyle alone. It is a clinical judgement, not something to request off a list.
The important limitation is durability. Medication effects in these trials diminished after the drug was stopped, whereas the lifestyle benefit persisted for decades. Metformin manages the risk while you take it; the habit changes the trajectory.