What happens if i stop taking metformin
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Effects of Stopping Metformin: A Comprehensive Overview
Introduction to Metformin and Its Use in Diabetes Management
Metformin is a widely prescribed medication for managing type 2 diabetes mellitus (T2DM). It is known for its efficacy in lowering blood glucose levels and improving metabolic parameters. However, patients may sometimes need to discontinue metformin due to various reasons, including side effects, contraindications, or changes in health status. Understanding the consequences of stopping metformin is crucial for both patients and healthcare providers.
Impact on Glycemic Control
Immediate Deterioration in Glycemic Control
One of the most immediate effects of stopping metformin is a significant deterioration in glycemic control. Studies have shown that patients who discontinue metformin experience substantial increases in hemoglobin A1c (HbA1c) levels, indicating poorer blood sugar management . This deterioration can be particularly severe in patients who had poor glycemic control before starting metformin.
Long-Term Risk of Developing Diabetes
In the context of diabetes prevention, discontinuing metformin has been associated with an increased risk of developing diabetes. The Diabetes Prevention Program (DPP) found that while metformin reduced the risk of diabetes by 31%, about 26% of this effect was lost after stopping the medication. However, even after discontinuation, the incidence of diabetes remained lower compared to those who never took metformin.
Effects on Body Weight and Metabolic Parameters
Weight Gain After Discontinuation
Metformin is known to aid in weight loss and improve metabolic profiles. However, these benefits are not sustained after stopping the medication. Research indicates that patients who discontinue metformin tend to regain the weight they had lost during treatment. This weight gain can negate the metabolic improvements achieved while on the drug.
Changes in Gut Hormones and Microbiota
Metformin has complex effects on gut hormones and microbiota, which contribute to its glucose-lowering effects. Discontinuation of metformin leads to a reduction in beneficial gut hormones like GLP-1 and an increase in serum bile acids, which can adversely affect glucose metabolism. These changes are reversible upon restarting the medication, highlighting the importance of continuous treatment for sustained benefits.
Cardiovascular and Renal Outcomes
Increased Cardiovascular and Renal Risks
Stopping metformin in patients with chronic kidney disease (CKD) or cardiovascular conditions can lead to worse outcomes. A study involving patients with advanced CKD found that discontinuation of metformin was associated with higher risks of major adverse cardiovascular events (MACE), heart failure, end-stage kidney disease (ESKD), and mortality. These findings suggest that the benefits of continuing metformin may outweigh the risks, even in patients with significant comorbidities.
Conclusion
Discontinuing metformin can have several adverse effects, including worsening glycemic control, weight gain, and increased cardiovascular and renal risks. While some benefits of metformin are lost upon discontinuation, the medication's protective effects on diabetes development and metabolic health underscore the importance of continuous treatment. Patients and healthcare providers should carefully weigh the risks and benefits before deciding to stop metformin, especially in those with existing comorbidities.
Sources and full results
Most relevant research papers on this topic