Since 2017, NICE guidelines have advised doctors to €use clinical judgement on whether (and when) to offer metformin to support lifestyle change for people whose HbA1c or fasting plasma glucose blood test results have deteriorated if:7

·       this has happened despite their participation in intensive lifestyle-change programmes, or

·       they are unable to participate in an intensive lifestyle-change programme,

particularly if they have a body mass index (BMI) greater than 35.€

Before initiating a patient on metformin (the first-line drug of choice), there should be a discussion about how €long-term lifestyle change can be more effective than drugs in preventing or delaying type 2 diabetes.€ Patients should be aware €that they might need to take metformin for the rest of their lives and inform them about possible side effects.€7

Once metformin is started, patients should still be supported to adopt a healthier lifestyle to reduce risk, addressing diet, weight loss and physical activity.