Metformin usage and prescription trends in the United States
Pro Research Analysisby 
Searched over 200M research papers
Metformin Prescription Trends in the United States
Rising Metformin Usage for Diabetes and Beyond
Metformin prescriptions in the United States have increased dramatically over the past two decades. From 2000 to 2015, the number of metformin prescriptions rose steadily, with FDA-approved uses increasing from 2.27 to 235 per 1,000 people and off-label uses rising from 0.74 to 20.3 per 1,000 people. The most significant growth was seen in adults aged 50 and older, but all age groups experienced increases. Off-label use was most common for endocrine, cardiovascular, female reproductive, and metabolic disorders .
Metformin as the Leading Diabetes Medication
Metformin remains the most commonly prescribed diabetes medication in the U.S. Between 2008 and 2015, the percentage of adults with diabetes using metformin increased from 47.8% to 59%. During this period, the use of other diabetes medications like sulfonylureas and thiazolidinediones declined, while newer drug classes such as DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors saw increased use. However, metformin, insulin, and sulfonylureas continued to be the top three prescribed classes Raval2020Hampp2014.
Trends in Combination Therapy and Add-On Medications
Metformin is often used as a first-line therapy, but many patients require additional medications. From 2015 to 2019, the use of sulfonylureas and DPP-4 inhibitors as second- and third-line add-ons after metformin declined, while the use of SGLT2 inhibitors and GLP-1 receptor agonists increased. These trends suggest that newer, evidence-based guidelines are influencing prescribing practices to better individualize diabetes care and prevent complications .
Off-Label and Adolescent Metformin Use
Metformin is also prescribed off-label, especially among adolescents. While it is the only oral antihyperglycemic agent approved for adolescents with type 2 diabetes, it is also used to treat obesity, prediabetes, metabolic syndrome, and polycystic ovarian syndrome (PCOS) in this age group Le2019Wang2016.
Metformin Use in Prediabetes
Despite recommendations to consider metformin for diabetes prevention in people with prediabetes, its use in this group remains low. From 2005 to 2014, the percentage of adults with self-reported prediabetes using metformin increased from 2.4% to 8.3%. Those who used metformin were more likely to be obese and actively trying to lose weight .
Prescription Patterns by Ethnicity and Language
Metformin prescription rates do not appear to be lower among Latino patients compared to non-Latino whites. In fact, Spanish-preferring Latinos had higher odds of receiving metformin and received prescriptions more quickly after a diabetes diagnosis or high blood sugar result. This suggests that disparities in diabetes outcomes among Latino patients may be due to factors other than prescription rates, such as medication adherence or access to lifestyle counseling .
Conclusion
Metformin use in the United States has grown substantially, driven by both increased diabetes prevalence and expanded off-label use. It remains the cornerstone of diabetes treatment, with evolving trends in add-on therapies reflecting updated clinical guidelines. While metformin use for prediabetes is increasing, it is still relatively uncommon. Prescription patterns are generally consistent across ethnic groups, indicating that other factors may contribute to disparities in diabetes outcomes.
Sources and full results
Most relevant research papers on this topic