Metformin Knocked Off Its Pedestal as First-Line Rx Choice for Type 2 Diabetes

From Diabetes Daily:

Metformin is the world’s most-prescribed diabetes drug. For a generation, most Americans with newly diagnosed type 2 diabetes have been prescribed metformin as their first medication.

But now metformin’s reign as the universally acknowledged “first-line” treatment for type 2 diabetes has come to an end. Updated guidance from the American Diabetes Association (ADA), released on December 12, 2022, has substantially minimized the importance of the popular drug. The ADA’s committee of experts removed metformin from key recommendations and now ranks the drug as inferior to other options for blood sugar control, weight loss, and long-term heart and kidney protection


The new ADA recommendation can be seen as a major endorsement for the stars of the newest generation of diabetes drugs: SGLT-2 inhibitors and GLP-1 and GIP/GLP-1 receptor agonists. These options combat hyperglycemia effectively but add other important benefits that metformin cannot claim: enhanced weight loss and more robust protection against cardiovascular and kidney disease.

IIRC, when I started my medical career in 1981 we had only three types of drugs for diabetes: metformin, sulfonylureas, and insulin. I’ve lost count, but we must have at least 8-10 classes now. We also have better science-based dietary approaches.

Steve Parker, M.D.

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