Review of Metformin Use for Type 2 Diabetes Prevention

Am J Prev Med. 2018 Oct;55(4):565-574. doi: 10.1016/j.amepre.2018.04.038. Epub 2018 Aug 17.


Context: Prediabetes is prevalent and significantly increases lifetime risk of progression to type 2 diabetes. This review summarizes the evidence surrounding metformin use for type 2 diabetes prevention.

Evidence acquisition: Articles published between 1998 and 2017 examining metformin use for the primary indication of diabetes prevention available on MEDLINE.

Evidence synthesis: Forty articles met inclusion criteria and were summarized into four general categories: (1) RCTs of metformin use for diabetes prevention (n=7 and n=2 follow-up analyses); (2) observational analyses examining metformin use in heterogeneous subgroups of patients with prediabetes (n=9 from the Diabetes Prevention Program, n=1 from the biguanides and the prevention of the risk of obesity [BIGPRO] trial); (3) observational analyses examining cost effectiveness of metformin use for diabetes prevention (n=11 from the Diabetes Prevention Program, n=1 from the Indian Diabetes Prevention Program); and (4) real-world assessments of metformin eligibility or use for diabetes prevention (n=9). Metformin was associated with reduced relative risk of incident diabetes, with the strongest evidence for use in those at highest risk (i.e., aged <60 years, BMI ≥35, and women with histories of gestational diabetes). Metformin was also deemed cost effective in 11 economic analyses. Recent studies highlighted low rates of metformin use for diabetes prevention in real-world settings.

Conclusions: Two decades of evidence support metformin use for diabetes prevention among higher-risk patients. However, metformin is not widely used in real-world practice, and enhancing the translation of this evidence to real-world practice has important implications for patients, providers, and payers.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Diabetes, Gestational / drug therapy
  • Diabetes, Gestational / prevention & control
  • Female
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Metformin / therapeutic use*
  • Obesity
  • Prediabetic State / drug therapy*
  • Pregnancy
  • Risk Factors


  • Hypoglycemic Agents
  • Metformin