From the Guidelines
You should not stop metformin after resolution of prediabetes without consulting your healthcare provider, as the decision to discontinue metformin should be based on individual factors, including the presence of other cardiovascular risk factors and the potential for metformin to provide long-term benefits beyond glucose control. The 2022 standards of medical care in diabetes recommend considering metformin therapy for the prevention of type 2 diabetes in adults with prediabetes, especially those with certain risk factors such as a BMI ≥35 kg/m2, higher fasting plasma glucose, and higher A1C 1. While lifestyle changes, such as weight loss and regular physical activity, are essential for managing prediabetes, metformin may be beneficial for individuals who have difficulty maintaining these changes or have other cardiovascular risk factors.
When considering discontinuing metformin, it's crucial to assess the individual's overall cardiovascular risk profile, as people with prediabetes often have other cardiovascular risk factors, including hypertension and dyslipidemia 1. The decision to stop metformin should be made in consultation with a healthcare provider, taking into account the individual's specific circumstances, including their blood glucose levels, other health conditions, and the potential benefits and risks of continuing or discontinuing metformin.
Some key points to consider when deciding whether to stop metformin include:
- The individual's blood glucose levels and A1C values, which should be regularly monitored to ensure that prediabetes does not return or progress to type 2 diabetes
- The presence of other cardiovascular risk factors, such as hypertension, dyslipidemia, or a history of gestational diabetes mellitus, which may influence the decision to continue or discontinue metformin
- The individual's ability to maintain healthy lifestyle changes, including regular physical activity, weight management, and a balanced diet, which are essential for managing prediabetes and preventing progression to type 2 diabetes.
In general, the benefits of metformin in preventing type 2 diabetes and reducing cardiovascular risk may outweigh the risks, and discontinuing metformin without a thorough evaluation of the individual's circumstances may not be advisable 1.
From the Research
Stopping Metformin After Resolution of Prediabetes
- There is no direct evidence in the provided studies to suggest that metformin should be stopped after the resolution of prediabetes 2, 3, 4, 5, 6.
- The studies primarily focus on the safety and efficacy of metformin in patients with type 2 diabetes and chronic kidney disease, rather than prediabetes.
- Metformin is recommended as a first-line therapy for type 2 diabetes due to its safety, low cost, and potential cardiovascular benefits 2.
- The use of metformin in patients with chronic kidney disease has been a topic of debate, but recent studies suggest that it can be used safely in patients with mild to moderate renal impairment, with appropriate dosage reductions and careful follow-up of kidney function 4, 5.
- One study suggests that metformin may have an adverse effect on renal function in patients with type 2 diabetes and moderate chronic kidney disease, but this does not directly address the question of stopping metformin after resolution of prediabetes 6.
Considerations for Metformin Use
- Metformin is generally considered safe for use in patients with type 2 diabetes and mild to moderate chronic kidney disease, but its use in patients with severe renal impairment is still a topic of debate 2, 3, 4, 5.
- The risk of lactic acidosis associated with metformin use in patients with impaired kidney function is considered low, but it is still a concern 5.
- Patients with chronic kidney disease should be carefully monitored and have their metformin dosage adjusted accordingly to minimize the risk of adverse effects 4, 5.