Metformin Recognized by ACP as Best Drug for Type 2

By Nora Saul, M.S., R.D., C.D.E., Manager of Nutritional Services at Joslin

The American College of Physicians (ACP) recently released its new guidelines for the treatment of type 2 diabetes.

After extensive review of the evidence, through a literature search spanning the years 1966 through 2010, the society concluded that metformin should be the primary drug of choice when lifestyle methods have failed to bring about glycemic control for patients.

Metformin, which has been in use for over 40 years, was found to have fewer side effects than drugs that cause the pancreas to secrete insulin and to be more effective in reducing A1C compared to other agents when taken alone or in combination with other drugs.

One of the most widely prescribed glucose lowering agents in use, its major effect is a reduction in insulin resistance.  It lowers levels of glucose in the blood by decreasing the liver’s output of glucose.  (The liver in people with diabetes often secretes an overabundance of glucose relative to the body’s needs, releasing approximately three times more glucose than in those without diabetes.)

Metformin also improves uptake of glucose by the muscle cells.

The medication does not generally cause hypoglycemia (low blood glucose), unlike many other oral agents. It has also been shown to be weight neutral (meaning it won’t cause you to put on pounds) and has a positive effect on cholesterol levels.

Metformin is generally used in the treatment of type 2 diabetes, but can also be used in conjunction with insulin in those patients with type 1 who are overweight. Caution is advised in using the drug in patients with impaired kidney function and in the elderly due to the possibility of lactic acidosis, or too much lactic acid in the bloodstream.

Recommendations from the ACP include:

  • Use metformin as the first drug of choice when lifestyle measures such as diet and exercise have failed.
  • Use metformin as the first drug of choice along with lifestyle measures to treat most patients with diabetes
  • Add another medication along with metformin when patients have persistent high blood glucose levels.
By Nora Saul, M.S., R.D., C.D.E., Manager of Nutritional Services at Joslin

The guidelines are similar to those promoted by the Joslin Diabetes Center which recommends consideration of metformin along with lifestyle modification as an initial approach to those with type 2 diabetes.


  1. Am a diabetic patient since 7 years. Last one week am having diatic diet by advice of 2000kcal per day and also using tablet AMRYL 2 MG ( contains Metformin hydrochloride(in sustained release form) 500mg and glimepride IP 1 MG.) still my blood sugar is verying from 120 to 130 @fasting and after food (2 hours) its comes 190 to 140).

    Could you please advise me… if this is ok for me, since am doing offshore job and more conciuos for health issues.Is it ok for me to work offshore and i can pass on my offshore medical fittness test.

    I had completed all test and very things are ok and HB1A is 6.9.

    Please advice.

  2. As many of those seeking treatment and relief from the effects of type 2 diabetes would be catergorized as being ‘elderly’ its as well to warn them that taking ‘melformin’ is not advised for these people because of the possibility of lactic acidosis (whatever that is)
    so an alternative medication should be suggested that is available from pharmacies without a prescription as many sufferers have not the resources or time to attend doctors’ surgeries. As many isolated areas are without trained medicos such advice given online would help relieve the pressure on medicos in the public arena who try to be all things to all people.

  3. Dear Sir,
    Recently I checked my wife blood-sugar, was 360 mgd, and contac the doctor,
    and was given medicine, but her bloodsugar after taking tablets remains 216 mgdl, and recently she got dyriaah, and feels weakness, so do we proceed with the medicament, and her family nobody has diabetic probs. So pls do advice to do what

  4. I am a 45 year old physician and was diagnosed with type 2 diabetes on November 1st, 2012. My hemoglobin A1C was 11 and my blood sugar level were around 300. I had no symptoms except blurry vision. I was started on Glumetza 1000 twice per day and Alpha Lipoic Acid 600 mg daily. My fasting blood sugars have been less than 120 and 2 hours post-pandrial have been less than 140. After 4 weeks of Glumetza I developed an abnormal sensation of taste. It is much worse with fatty foods and proteins. Essentially it is a loss of taste in the back of the tongue/palate and a strange sensation to the texture of the food. I am not experiencing a metallic taste. This has caused a significant decrease in my food intake and a lot of anxiety. I also take Exforge and Nexium. I believe this condition is called Dysguestia. I quit the Glumetza one week ago without much improvement. Fortunately, my blood sugars have been controlled. Have you heard about other cases of Glumetza causing this? Could it be a drug interaction? Could this be an odd neuropathy? Please advise. HD

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