Can You Get Off Metformin? Who Succeeds and How

Quick answer

Some people with type 2 diabetes can safely stop metformin, but only with their doctor's guidance. The best chances belong to people diagnosed recently who have lost a meaningful amount of weight and kept it off. Remission is defined as an HbA1c below 6.5% (48 mmol/mol) at least 3 months after stopping all diabetes medicine. After stopping, HbA1c should be checked regularly, because blood sugar can creep back up.

Table of contents

1. Can you stop taking metformin? What remission really means

2. Why people want to stop: side effects and vitamin B12

3. Good reasons to stay on metformin

4. Who is most likely to come off metformin successfully

5. How to reduce metformin safely: a step-by-step plan with your doctor

6. What to monitor after stopping, and warning signs

7. Habits that keep blood sugar normal without medicine

8. Frequently asked questions

9. References

Can you stop taking metformin? What remission really means

A nervous new member of a UK diabetes forum asked a simple question: had anyone steadied their blood sugar and come off metformin? Several members replied that they had. The honest answer is yes, many people have. But it is not right for everyone, and it should never be done alone.

Metformin is the most widely used first medicine for type 2 diabetes. Stopping it is a medical decision, sometimes called deprescribing. Your doctor will weigh your blood sugar, your heart and kidney health and your other medicines.

What counts as remission?

In 2021, an international expert group convened by the American Diabetes Association agreed on a definition. Remission means an HbA1c below 6.5% (48 mmol/mol), measured at least 3 months after stopping all glucose-lowering medicine [1].

Two details matter here:

• Remission is not the same as a cure. The expert group chose "remission" as the right term and recommended ongoing checks, because blood sugar can rise again [1].

• A normal HbA1c while still taking metformin is good control, not remission. It shows the medicine is working, not that you no longer need it.

The goal of coming off metformin is to see whether your body can now keep blood sugar normal on its own.

Why people want to stop: side effects and vitamin B12

Stomach side effects

Metformin's most common side effects are digestive: diarrhea, nausea, bloating and stomach discomfort. For many people these settle within weeks. For some they don't. One forum member described stopping metformin because living with the side effects had become too unpleasant.

If side effects are your main reason for wanting to stop, ask your doctor about two options first. Taking metformin with meals, or switching to an extended-release version, often makes it easier to tolerate [2].

Low vitamin B12

Long-term metformin use can lower vitamin B12 levels. The best evidence comes from the US Diabetes Prevention Program and its follow-up study, which tracked people on metformin or placebo for up to 13 years.

At 5 years, low or borderline-low B12 was found in 19.1% of people taking metformin, compared with 9.5% on placebo. Each extra year on metformin raised the odds of B12 deficiency by 13%. Neuropathy, such as numbness or tingling in the feet, was more common in metformin users with low B12 [4].

The authors recommended considering routine B12 testing in people on metformin [4]. Low B12 is easy to treat with supplements or injections, so it is rarely a reason by itself to stop metformin. But it is worth checking.

Wanting to manage diabetes naturally

Many people simply want to know whether their lifestyle changes are enough on their own. That is a fair goal. The rest of this guide explains how to find out safely.

Good reasons to stay on metformin

Coming off metformin is not automatically the healthier choice. Metformin has a long safety record and real benefits.

The landmark UK Prospective Diabetes Study followed overweight adults with newly diagnosed type 2 diabetes for a median of about 11 years. Compared with diet-based care alone, people on metformin had a 32% lower risk of any diabetes-related complication, a 42% lower risk of diabetes-related death and a 36% lower risk of death from any cause [3].

Metformin also does not cause weight gain and rarely causes low blood sugar on its own [3].

When staying on it usually makes sense

• HbA1c still at or above 6.5% (48 mmol/mol) on metformin: Your blood sugar still needs the help

• Heart disease, kidney disease or heart failure: Your doctor may want to keep or add medicines that protect these organs [2]

• Diabetes for many years: Remission is less likely the longer diabetes has been present [7]

• You feel well on it with no side effects: There may be little to gain from stopping

Staying on metformin while you build healthy habits is not a failure. The habits still lower your risks, with or without the medicine.

Who is most likely to come off metformin successfully

The best evidence on this question comes from the UK DiRECT trial. In DiRECT, people stopped all their diabetes and blood pressure medicines on day one, then followed a structured weight-loss program [5].

Weight loss is the strongest predictor

At 12 months, 46% of the program group were in remission. Across everyone in the trial, the more weight people lost, the more likely they were to be in remission [5]:

• Gained weight: 0%

• 0 to 5 kg (0 to 11 lb): 7%

• 5 to 10 kg (11 to 22 lb): 34%

• 10 to 15 kg (22 to 33 lb): 57%

• 15 kg (33 lb) or more: 86%

Shorter diabetes duration helps

A detailed DiRECT sub-study looked at what set successful people apart. Liver fat and pancreas fat fell in almost everyone who lost weight. The difference was whether the insulin-making beta cells recovered their early response to food. Those who reached remission had shorter diabetes duration, about 2.7 years compared with 3.8 years [7].

The researchers concluded that the beta cells' ability to recover persists for some years after diagnosis [7]. That is encouraging, but it also suggests that acting earlier gives better odds.

Other things that help

• Not using insulin. In a review of low-carb diet trials, remission was much less likely in studies that included insulin users [8].

• Keeping the weight off. At 5 years in DiRECT, people who kept up with support had more time off medicine and more time in remission [6].

How to reduce metformin safely: a step-by-step plan with your doctor

This plan is for discussion with your doctor. It is not a do-it-yourself schedule.

1. Build the habits first. Spend at least 3 months on steady changes: a lower-carb or Mediterranean-style eating pattern, regular walks after meals and strength training. Aim for meaningful, lasting weight loss if you carry extra weight [5].

2. Get a baseline. Ask for an HbA1c test while still on your current dose. A level comfortably below 6.5% (48 mmol/mol) is a better starting point than one just under it.

3. Agree on a plan. Your doctor may stop metformin outright, as in DiRECT [5], or lower the dose in steps. Ask which approach suits you and why.

4. Check your glucose at home. In the weeks after a change, check fasting and post-meal readings a few times a week. Share them with your care team.

5. Recheck HbA1c after 3 months. This is the test that shows whether your body is holding normal blood sugar without the medicine [1].

6. Decide together. If HbA1c stays below 6.5% (48 mmol/mol), you meet the definition of remission [1]. If it rises above your target, restarting metformin is a sensible, safe step.

If you take other diabetes medicines

People on several medicines usually reduce one at a time. Insulin and sulfonylureas (such as gliclazide or glipizide) carry a risk of low blood sugar when you cut carbohydrates. These are often the first medicines a doctor reduces when diet changes are working. Never change insulin doses without medical advice.

What to monitor after stopping, and warning signs

Remission needs follow-up. The expert consensus recommends that people in remission keep having HbA1c checked, at least once a year [1].

• HbA1c: How often — Every 3 months at first, then at least yearly [1]; Why — Shows whether blood sugar is staying normal

• Weight and waist: How often — Weekly at home; Why — Regaining weight is linked to losing remission [6]

• Home glucose (if you have a meter): How often — A few times a week at first; Why — Spots a rise early

• Eyes, feet, kidneys and blood pressure: How often — As advised by your doctor; Why — Complication checks still matter after remission [1]

• Vitamin B12: How often — If you took metformin for years; Why — Low levels can persist and are easy to treat [4]

Warning signs to act on

• Unusual thirst, passing urine often or blurred vision

• Home fasting readings repeatedly above about 7 mmol/L (126 mg/dL)

• Weight creeping back up by several kilograms

• An HbA1c result at or above 6.5% (48 mmol/mol)

If any of these appear, contact your doctor. Restarting medicine is not a step backward. It protects your eyes, kidneys, nerves and heart while you work on the habits again.

Habits that keep blood sugar normal without medicine

Coming off metformin is the easy part. Staying off it depends on keeping the changes that got you there.

Protect your weight loss

In DiRECT, remission at 2 years was closely tied to keeping weight off. Of those who kept off at least 10 kg (22 lb), 64% were still in remission [9]. Weigh yourself regularly and act quickly if the number climbs.

Keep carbohydrates in check

A review of 23 trials found more people reached HbA1c below 6.5% on low-carbohydrate diets at 6 months [8]. A moderate approach that you can keep for years works better than a strict one you abandon.

Move after meals and build muscle

A walk soon after eating lowers the blood sugar rise better than exercise before the meal [10]. Strength training two or three times a week helps your muscles take up glucose.

Keep your support

At 5 years in DiRECT, people who received ongoing low-intensity support had more time in remission and more time off diabetes medicine than those whose support stopped [6]. Find a dietitian, a program, a group or a friend to keep you on track.

Frequently asked questions

Can I just stop taking metformin?

Don't stop on your own. Talk to your doctor first. Stopping may be safe if your blood sugar is well controlled through lifestyle changes, but your HbA1c needs checking about 3 months later to confirm your body can manage without it [1].

What happens when you stop metformin?

If your diabetes is in remission, blood sugar stays normal. If not, it will gradually rise. Digestive side effects usually settle quickly after stopping.

Who can come off metformin?

People with a shorter history of diabetes who have lost meaningful weight have the best chance. In DiRECT, 86% of people who lost 15 kg or more were in remission at 1 year [5].

Does metformin cause vitamin B12 deficiency?

It can, especially with long-term use. In the Diabetes Prevention Program follow-up, each year of metformin use raised the odds of B12 deficiency by 13% [4]. Ask your doctor about B12 testing.

Is metformin bad for you long term?

No. In the UK Prospective Diabetes Study, metformin lowered the risk of death from any cause by 36% in overweight people with type 2 diabetes [3]. Its main long-term issue is low B12, which is easy to check and treat.

How long after stopping metformin should I check my A1C?

About 3 months. That is how long HbA1c takes to reflect your new blood sugar levels, and it matches the expert definition of remission [1].

Take the next step

The Type II Remission Strategy sets out the full eating, fasting and exercise plan that gives you the best chance of reaching remission.

Related reading on this site: Low-calorie vs low-carb for remission · Just diagnosed with type 2 diabetes · Why your A1C isn't going down.

About this article

Written by Dr. Sayantan Banerjee. Last reviewed: October 2026.

This article is for general information and is not medical advice. Never stop or change a prescribed medicine without talking to your doctor.

References

1. Riddle MC, Cefalu WT, Evans PH, et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care. 2021;44(10):2438-2444. doi:10.2337/dci21-0034

2. American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Suppl 1):S183-S215. doi:10.2337/dc26-S009

3. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854-865. doi:10.1016/S0140-6736(98)07037-8

4. Aroda VR, Edelstein SL, Goldberg RB, et al. Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016;101(4):1754-1761. doi:10.1210/jc.2015-3754

5. Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541-551. doi:10.1016/S0140-6736(17)33102-1

6. Lean MEJ, Leslie WS, Barnes AC, et al. 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study. Lancet Diabetes Endocrinol. 2024;12(4):233-246. doi:10.1016/S2213-8587(23)00385-6

7. Taylor R, Al-Mrabeh A, Zhyzhneuskaya S, et al. Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for β cell recovery. Cell Metab. 2018;28(4):547-556.e3. doi:10.1016/j.cmet.2018.07.003

8. Goldenberg JZ, Day A, Brinkworth GD, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data. BMJ. 2021;372:m4743. doi:10.1136/bmj.m4743

9. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7(5):344-355. doi:10.1016/S2213-8587(19)30068-3

10. Engeroff T, Groneberg DA, Wilke J. After dinner rest a while, after supper walk a mile? A systematic review with meta-analysis on the acute postprandial glycemic response to exercise before and after meal ingestion. Sports Med. 2023;53(4):849-869. doi:10.1007/s40279-022-01808-7