Diabetes Treatment Assessment Tool
This tool helps you evaluate if metformin is the right choice for your current situation or if you might benefit from discussing newer alternatives with your doctor.
Results will appear here after you click 'Assess My Treatment Options'
Metformin has been the go-to pill for type 2 diabetes for over 60 years. It’s cheap, widely available, and often the first prescription a doctor gives. But if you’ve been listening closely in waiting rooms or online forums, you’ve probably heard whispers: metformin isn’t as perfect as it seems. Some doctors are quietly moving away from it-not because it doesn’t work, but because it’s not always the best choice anymore.
It doesn’t help everyone lose weight
One of the biggest reasons metformin was pushed as a miracle drug was its supposed ability to help people lose weight. Many patients were told, ‘This will help you shed a few pounds and control your blood sugar.’ But here’s the truth: studies show that on average, people lose about 2 to 4 kilograms (4.5 to 9 pounds) over six months. For someone with 30 kilograms to lose, that’s barely a start. And for many, the weight loss stops after a few months. Doctors see patients who’ve been on metformin for years, still struggling with obesity, and wonder why they didn’t get something more effective from the beginning.
The GI side effects are worse than people admit
Diarrhea, bloating, nausea, gas-these aren’t just minor inconveniences. They’re common, persistent, and often enough to make people quit the drug. Up to 30% of patients stop taking metformin within the first year because of stomach issues. Some patients say it feels like their gut is in constant revolt. One woman in Sydney told her endocrinologist she’d rather take insulin than deal with the daily bathroom runs. That’s not rare. Doctors know this. They’ve seen patients switch to other medications just to get through the day without anxiety over where the nearest toilet is.
It doesn’t protect the heart like newer drugs
Metformin was once thought to reduce heart disease risk because people on it seemed to have fewer heart attacks. But that was correlation, not causation. People on metformin were often younger, healthier, and more active. Newer drugs like semaglutide (Ozempic), liraglutide (Victoza), and empagliflozin (Jardiance) have been proven in large clinical trials to actually reduce heart attacks, strokes, and heart-related deaths in people with diabetes. These drugs don’t just lower blood sugar-they actively protect the heart. When a patient has high blood pressure, high cholesterol, and diabetes, doctors now ask: why start with a drug that doesn’t protect the heart when we have ones that do?
It doesn’t work well for advanced diabetes
Metformin is great for early-stage type 2 diabetes. But if someone’s HbA1c is above 8.5% and their pancreas is already struggling to make insulin, metformin alone won’t cut it. It works by making the body use insulin better, not by making more of it. When the body stops producing insulin, metformin becomes useless. Doctors see patients who’ve been on metformin for 10 years, now needing multiple injections, and realize they waited too long to escalate treatment. That delay can lead to nerve damage, kidney problems, and vision loss. Metformin isn’t dangerous-but delaying stronger treatments because you’re clinging to it can be.
It’s not safe for everyone
Metformin is cleared by the kidneys. If someone has even mild kidney decline-which is common in older adults or those with long-term diabetes-the drug can build up in the body. That raises the risk of lactic acidosis, a rare but deadly condition. A 2023 study in the Journal of the American Society of Nephrology found that patients over 70 with even slightly reduced kidney function had a 40% higher risk of complications from metformin. Doctors now check kidney function before prescribing it-and often avoid it altogether in older patients. For a 75-year-old with diabetes and a creatinine level of 1.4, metformin isn’t just risky-it’s a red flag.
There are better alternatives now
Since 2015, we’ve had a wave of new diabetes drugs that don’t just manage blood sugar-they change outcomes. GLP-1 agonists like semaglutide and tirzepatide (Mounjaro) not only lower blood sugar but also cause significant weight loss (up to 15% of body weight), reduce heart risks, and even improve liver health in people with fatty liver disease-a common companion to type 2 diabetes. SGLT2 inhibitors like dapagliflozin protect the kidneys and reduce hospitalizations for heart failure. These drugs are more expensive, yes. But for many patients, the long-term savings on hospital visits, dialysis, and amputations make them worth it. Doctors are no longer choosing between ‘cheap and safe’ and ‘expensive and better.’ They’re choosing ‘what actually improves survival and quality of life.’
Metformin still has a place-but not as the first choice
That doesn’t mean metformin is useless. For a 45-year-old with prediabetes, mild weight gain, and healthy kidneys, it’s still a reasonable starting point. It’s also used in polycystic ovary syndrome (PCOS), where it can help with ovulation. But for the average 58-year-old with type 2 diabetes, high blood pressure, and a BMI over 30, starting with metformin is like putting a bandage on a broken bone. Doctors now start with drugs that target multiple problems at once: weight, heart, kidneys, and blood sugar. They’re not avoiding metformin because they don’t understand it. They’re avoiding it because they’ve seen what happens when you wait too long to use something better.
What patients should ask their doctor
If you’re on metformin and wondering if you should stay on it, here are three questions to ask:
- Is my kidney function still normal? (Ask for your eGFR number)
- Am I still losing weight or is my blood sugar getting harder to control?
- Are there newer drugs that could protect my heart or kidneys better than this one?
Don’t be afraid to ask about alternatives. Your doctor isn’t hiding something. They’re just working with what they’ve learned in the last five years. And that’s a good thing.
It’s not about the drug-it’s about the patient
Doctors don’t dislike metformin because it’s old. They dislike using it as the default for everyone. Medicine isn’t about sticking to what’s familiar. It’s about using the right tool for the job. Metformin was the best tool we had in 1995. Today, we have better ones. The goal isn’t to control blood sugar with the cheapest pill. It’s to help people live longer, healthier lives without dialysis, heart attacks, or amputations. That’s why more doctors are moving past metformin-not out of dislike, but out of responsibility.
Is metformin still safe to take?
Yes, metformin is safe for many people, especially those under 70 with healthy kidneys and early-stage diabetes. But it’s not safe for everyone. If you have reduced kidney function, heart failure, or severe liver disease, your doctor may advise against it. Always get your kidney function checked before starting or continuing metformin.
Why do some doctors still prescribe metformin?
Because it still works for some patients-especially younger, leaner individuals with prediabetes or PCOS. It’s also much cheaper than newer drugs, which matters for people without good insurance. Doctors use it when it fits the patient’s profile, not as a one-size-fits-all solution.
Can metformin cause vitamin B12 deficiency?
Yes. Long-term use of metformin (over 4 years) is linked to lower vitamin B12 levels in up to 30% of users. This can cause fatigue, nerve tingling, or even anemia. Doctors should check B12 levels every 2-3 years if you’re on metformin long-term. Supplements can fix this easily.
What are the best alternatives to metformin?
For weight loss and heart protection: GLP-1 agonists like semaglutide (Ozempic) or tirzepatide (Mounjaro). For kidney and heart protection: SGLT2 inhibitors like dapagliflozin (Farxiga) or empagliflozin (Jardiance). These drugs are now recommended as first-line options for many patients with type 2 diabetes and heart or kidney risks.
Is metformin banned in any countries?
No, metformin is not banned anywhere. But some countries, like the UK and Australia, now recommend newer drugs as first-line treatment for patients with heart disease, obesity, or kidney issues. Guidelines have changed-not because metformin is dangerous, but because better options exist.
What to do next
If you’re on metformin and feel fine, don’t stop it suddenly. Talk to your doctor about your goals. Are you trying to lose weight? Protect your heart? Avoid insulin? Your treatment plan should match those goals. If you’ve been on metformin for years and your HbA1c is still above 7%, or you’re gaining weight, it’s time to have a real conversation. The goal isn’t to chase the cheapest pill. It’s to live well for as long as possible.
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