How do you counsel someone about metformin use for type 2 diabetes mellitus who is also on a GLP-1 agonist and achieved goal HbA1c, but prefers not to be on metformin anymore?

I am all for this! I realize metformin is still "first line" technically, but so many patients are having a robust response to GLP-1as that I think this may change. Given that GLP-1as have a lower risk of hypoglycemia plus the cardiovascular benefits, I think monotherapy is very appropriate. Also, A...

I would first explore their reasoning for not wanting to be on metformin. I have so many patient years of experience with the medication, and although the mechanism of action is still a bit mysterious, I believe it to be the mainstay of diabetes management, and prior to the GLP-1a arriving on the sc...