Metformin · Type 2 diabetes

Metformin prescribed against your A1C, your kidney function, and your B12 trend.

Clara reads your A1C trajectory, your kidney function, your prior anti-diabetic medications, and your vitamin B12 level before drafting a starting dose. A physician signs off on every Rx.

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Diabetes monitoring · 18 months on metformin

Needs review

A1C (current)7.4% ≤6.5% target

eGFR58 mL/min/1.73m² stable

Current doseMetformin 1000 mg BID unchanged 12 months

Vitamin B12198 pg/mL 200–900 normal

Clara: Your A1C remains above target on max-dose metformin, and your B12 is at the low end of normal after 18 months of therapy. I'll draft an add-on therapy summary and a B12 supplementation plan for our physician to review.

Values and scenarios shown are illustrative examples only. All clinical assessments are individualized and reviewed by a licensed physician.

How it works

Connect your records. Clara reads the full picture. A physician signs off on every clinical action.

Connect your records

Clara auto-syncs your medical records from 150,000+ doctors' offices, hospitals, labs, and pharmacies: every prior lab, every prescription, every diagnosis. Wearable data syncs automatically on Standard and Concierge plans. Free to start, no credit card.

Clara checks candidacy, interactions, and dose

Before drafting any prescription, Clara reads your full chart: indication, contraindications, every drug and supplement on your list, and any prior trials of this medication. The interaction check runs against the full FDA label — not just the common flagged pairs.

Physician-reviewed Rx, then on-clock monitoring

Every prescription is reviewed and signed off by a licensed physician before it reaches your pharmacy. Clara then tracks the key monitoring labs on schedule — not at your next annual visit — and flags when dose adjustment or follow-up is warranted.

About metformin

Metformin: what it treats, who it's for, and what Clara reads before prescribing.

FDA-approved indications

✓Type 2 diabetes mellitus in adults and pediatric patients aged 10 years and older, as an adjunct to diet and exercise to improve glycemic control

~Prediabetes / insulin resistance and PCOS-related insulin resistance are common off-label uses supported by guidelines; off-label prescribing is at physician discretion

Who Clara evaluates for metformin

✓Adults newly diagnosed with type 2 diabetes who need first-line therapy along with lifestyle changes

✓Adults with prediabetes (A1C 5.7–6.4%) where physician review supports metformin to delay or prevent progression to T2D

✓Patients already on a stable metformin regimen who need dose review, refills, and on-schedule lab monitoring

✗Patients with severe renal impairment (eGFR <30 mL/min/1.73m²) or acute/chronic metabolic acidosis including diabetic ketoacidosis

What Clara checks

Four things Clara reads before drafting — and keeps reading after.

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Indication and candidacy

Clara reads your A1C, your fasting glucose, your renal function, and your prior anti-diabetic medications before confirming metformin candidacy. It cross-checks renal function against contraindication thresholds (eGFR <30) and screens for any current contrast study or recent contrast exposure — metformin is held for iodinated contrast in patients with eGFR 30–60.

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Drug and supplement interactions

Iodinated contrast media (temporary hold required around contrast in patients with eGFR 30–60). Carbonic anhydrase inhibitors, topiramate, and zonisamide (increased lactic acidosis risk). Cimetidine, ranolazine, dolutegravir, vandetanib (raise metformin levels via OCT2). Alcohol (lactic acidosis risk; advise moderation). Clara reads your full medication list before drafting.

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Dose sizing

Per the metformin prescribing information, immediate-release: starting dose 500 mg twice daily or 850 mg once daily with meals, titrated weekly to a usual maintenance of 1500–2000 mg/day, max 2550 mg/day. Extended-release: starting 500 mg once daily, max 2000 mg/day. Lower doses recommended for eGFR 30–45.¹

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On-schedule monitoring

A1C at 3 months after initiation or any dose change. eGFR at baseline and at least annually (more often if eGFR <60 or with intercurrent illness). Vitamin B12 every 1–2 years, especially in patients on long-term therapy or at risk for deficiency. Symptom monitoring for lactic acidosis (rare but serious).

Important safety information

Metformin (Glucophage) is a prescription medication. The following is a summary of key safety information from the FDA-approved prescribing information. This is not a complete list — see the full prescribing information linked in the footer.

Boxed warning

Lactic acidosis is a rare but serious metabolic complication that can occur due to metformin accumulation. Onset is often subtle, with nonspecific symptoms (malaise, myalgia, respiratory distress, somnolence, abdominal pain). Risk factors include renal impairment, concomitant use of certain drugs, age ≥65, radiologic contrast study, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment.

Contraindications

Severe renal impairment (eGFR <30 mL/min/1.73m²). Acute or chronic metabolic acidosis, including diabetic ketoacidosis with or without coma. Known hypersensitivity to metformin. Temporary discontinuation around iodinated contrast in patients with eGFR 30–60.

Warnings and adverse reactions

Vitamin B12 deficiency (long-term use; periodic measurement recommended). Hypoglycemia when used with insulin or insulin secretagogues. Hepatic impairment (avoid in patients with significantly impaired hepatic function). The most common adverse reactions are diarrhea, nausea/vomiting, flatulence, asthenia, indigestion, abdominal discomfort, and headache. GI side effects are usually self-limiting and improve with extended-release formulation or with taking the dose with meals.

Special populations

Pregnancy: metformin crosses the placenta; consult physician — many guidelines support metformin in gestational diabetes after first-line lifestyle measures. Lactation: present in breast milk in small amounts; generally considered compatible. Pediatric: approved for ≥10 years with type 2 diabetes. Geriatric: increased monitoring of renal function recommended. Renal impairment: do not initiate if eGFR 30–45; assess risk/benefit and adjust dose.

Why Clara

How Clara manages metformin differently.

	Clara	Single-condition diabetes telehealth	General telehealth	Your doctor
Cost to start	Free (records + chat)	Subscription required	Per-visit fee	$150+ copay
Monthly cost	From $25/mo · Standard $50/mo · HSA/FSA eligible	Cash-pay subscription	Per-visit, varies	Per-visit copay
Reads kidney function before prescribing	✓ Pulls eGFR from chart	Intake questionnaire only	Self-reported	✓
Tracks B12 on schedule	✓ Annually for long-term users	Not typically tracked	Not typically tracked	At physician discretion
Prescription may be covered by your insurance	✓ Generic, low-cost	Often bundled cash-pay	Varies	✓
Biomarker panel included	✓ 74–108 tests in membership	Extra cost	Extra cost	Per-test copay
Full primary care (beyond diabetes)	✓	Single-condition	Single-condition	✓

The AI difference

What an AI that reads your full chart makes possible in primary care.

A clinician in a 15-minute visit reads the last panel. Clara reads every result you've ever had drawn — every lab, every wearable reading, every medication change — and cross-references them in a single pass. That's not a time-management difference. It's a category-of-work difference. The AI handles the data; licensed physicians handle every clinical decision.

Reads your entire chart, every time

Clara auto-syncs from 150,000+ medical sources and reads every prior result, medication, and diagnosis together — not just the last visit's notes. Pattern-finding across years of data is what the AI is built for.

Continuous monitoring, not annual snapshots

Clara watches for drift between visits — a creeping lab value, a wearable trend, a new medication interaction — and surfaces it when it's actionable, not when you happen to schedule an appointment.

Physician review on every clinical action

Clara drafts; physicians decide. Every prescription and lab order is reviewed and signed by a licensed clinician before it reaches your pharmacy or lab. The AI handles intake, reasoning, and follow-up. The physician handles sign-off.

Common questions

Metformin with Clara: questions patients ask.

What does Clara cost?

Connecting your medical records and chatting with Clara is free. To access physician-reviewed prescriptions and lab orders, plans start at $50/month. Standard ($50/mo) includes 74 biomarker tests, wearable integration, and weekly record sync. Concierge ($150/mo) includes 108 biomarker tests and expanded panels. All plans are HSA/FSA eligible. Biomarker panels are included in the membership — not billed separately and not billed to insurance. Medications and ad-hoc lab orders are billed by your pharmacy or lab and may be covered by your insurance.

Can I use my insurance, HSA, or FSA?

Clara's membership is cash-pay and not billed through insurance, but every plan is HSA/FSA eligible. Prescriptions Clara's physicians write go to your pharmacy and may be covered by your plan like any other script — Clara prescribes FDA-approved branded and generic medications, not compounded formulations. Ad-hoc lab orders may also be covered by your insurance when applicable.

Is Clara a real medical practice?

Yes. Clara operates through affiliated professional corporations licensed in all 50 states. All diagnoses, prescriptions, and lab orders are reviewed and signed off by licensed physicians. Clara's AI handles intake, continuous monitoring, and clinical reasoning — the physician sign-off happens before any clinical action reaches you.

How is this different from my regular doctor?

A 15-minute annual visit can review your most recent results. Clara reads every lab you've had drawn, every medication you've been on, and every wearable data point in a single pass — and does it every time you interact, not just at annual visits. Your PCP remains the right choice for in-person exams, procedures, and anything Clara refers out. Clara fills the continuous monitoring gap between visits.

Is my data private?

Clara is HIPAA compliant. Your medical records and wearable data are used solely to personalize your care. They are not sold to third parties and are not used to train public AI models.

Is generic metformin the same as Glucophage?

Yes. Generic metformin is bioequivalent to brand-name Glucophage and is the cost-effective default for nearly every patient. Clara prescribes generic immediate-release or extended-release metformin per the patient's tolerance and dosing preference. Extended-release formulations are often better tolerated for GI side effects.

Why might Clara check my B12 if I'm on metformin?

Long-term metformin use is associated with reduced vitamin B12 absorption and clinically significant B12 deficiency in a meaningful subset of patients. The FDA label recommends periodic B12 measurement, particularly in patients on long-term therapy or with risk factors for B12 deficiency. Clara prompts a B12 level at baseline and on a 1–2 year cadence.

What if I'm getting GI side effects from metformin?

GI side effects (nausea, diarrhea, abdominal discomfort) are common in the first weeks and often improve with continued use, taking the dose with meals, or switching to extended-release. Persistent severe symptoms — or symptoms suggestive of lactic acidosis (severe weakness, breathing changes, abdominal pain) — should be flagged immediately. Clara reads your report and our physician adjusts the formulation, dose, or therapy.