From the Guidelines
Metformin should not be stopped after resolution of diabetes without careful consideration and medical supervision, as it may lead to recurrence of diabetes and negatively impact morbidity, mortality, and quality of life. The decision to stop metformin should be based on individual patient factors, including the duration of diabetes resolution, lifestyle modifications, and underlying health conditions. According to the 2017 American Diabetes Association standards of medical care in diabetes 1, metformin is a preferred initial pharmacologic agent for type 2 diabetes due to its efficacy, safety, and potential to reduce cardiovascular events and death.
When considering stopping metformin, it is essential to monitor blood glucose levels closely, as diabetes may recur after discontinuation of the medication. The typical approach involves gradually tapering the medication rather than stopping abruptly to monitor how the patient's body responds. Regular follow-up appointments every 3-6 months are recommended to check HbA1c and fasting glucose levels. Key factors to consider when deciding to stop metformin include:
- Duration of diabetes resolution
- Lifestyle modifications, such as weight loss, dietary changes, and regular exercise
- Underlying health conditions, such as cardiovascular disease or kidney disease
- Patient preferences and values
It is crucial to weigh the potential benefits of stopping metformin against the potential risks, including recurrence of diabetes and negative impacts on morbidity, mortality, and quality of life. As stated in the 2016 American Diabetes Association standards of medical care in diabetes 1, metformin therapy can be continued in patients with declining renal function down to a glomerular filtration rate (GFR) of 30 to 45 mL/min, although the dose should be reduced. Therefore, the decision to stop metformin should be made on a case-by-case basis, taking into account individual patient factors and medical supervision.
From the Research
Stopping Metformin After Resolution of Diabetes
- The decision to stop metformin after resolution of diabetes should be based on individual patient characteristics and medical history 2.
- A study published in 2002 found that in type 2 diabetic patients treated with insulin plus metformin, glycaemic control can be maintained after discontinuation of metformin by increasing the daily dose of insulin substantially 2.
- However, there is no clear evidence to suggest that metformin should be stopped after resolution of diabetes, as it may still provide benefits in terms of cardiovascular risk reduction and insulin sensitivity 3, 4.
- Other studies have compared the effects of metformin with other medications, such as pioglitazone, on glycemic control and insulin sensitivity, but these studies do not directly address the question of stopping metformin after resolution of diabetes 5, 6.
- It is essential to consider the individual patient's response to metformin and their overall health status before making a decision to stop the medication 2.
- In general, the management of type 2 diabetes should be tailored to the individual patient, taking into account their unique characteristics, medical history, and response to treatment 3, 4, 5, 6.