‘Why do doctors prescribe Metformin for pre-diabetes if it is also used later for diabetes?’

Although Metformin is commonly known as a diabetes medication, early use in pre-diabetes targets the same underlying issue of insulin resistance. “By addressing this problem sooner, Metformin can slow disease progression and lower the risk of complications. This proactive approach makes Metformin a valuable tool in both pre-diabetes and diabetes care, as it supports healthier long-term blood sugar control,” said Kanikka Malhotra, consultant dietician and diabetes educator.

Are you a pre-diabetic? (Photo: Freepik)

Notably, Metformin, which has been used for decades in India, belongs to a group of medicines called biguanides. “Unlike many drugs, Metformin does not increase insulin production; instead, it helps the body’s own insulin work more effectively,” said Dr Ghody.

It does this by reducing sugar release from the liver and improving insulin sensitivity in muscle and fat cells.

Dr Ghody said that doctors usually consider it for people who are overweight, under 60 years old, have a strong family history of diabetes, or women with polycystic ovary syndrome (PCOS). “In these high-risk groups, making lifestyle changes alone may not be enough, and Metformin provides an extra layer of protection,” said Dr Ghody.

What should people note before starting Metformin?

– Lifestyle first: Diet, exercise, and weight management are the foundation. “Metformin is usually prescribed when risks are high or when lifestyle changes aren’t enough,” said Dr Ghody.
– Tolerability: Most people tolerate it well, but some may experience stomach upset at first. “Taking it with meals can help reduce side effects,” said Dr Ghody.
– Safety: It is generally safe, but kidney function should be checked before starting and monitored regularly.
– Not a shortcut: Metformin is not a “license” to eat anything. It works best when paired with healthy habits, said Dr Ghody.

How long to take?

For someone with prediabetes, taking Metformin usually means a commitment of several years, often around three, but this can vary based on how the person responds to the medication and lifestyle changes, said Malhotra. “Many people start on a low dose and only increase it if needed, making it easier to manage any side effects, like stomach upset,” said Malhotra.

The key is to understand that Metformin isn’t a quick fix—it’s like a helpful partner alongside healthy eating and regular exercise. According to Malhotra, doctors monitor progress regularly to decide when or if the medication can be reduced or stopped. “For some, with good lifestyle changes, prediabetes can even be reversed, reducing the need for medication over time. So, it’s a long-term, supportive approach rather than just a medicine to take briefly,” said Malhotra.

Therefore, Metformin is not just a diabetes drug; it can also be a prevention tool for those at high risk for pre-diabetes. “The goal is to delay or avoid diabetes altogether, and when used wisely, Metformin supports that journey,” said Dr Ghody.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.