IN BRIEF Adherence to metformin-based treatment regimens for type 2 diabetes is currently suboptimal due to a complex array of patient-, treatment-, and physician-related barriers, including physical and psychological swallowing difficulties associated with large tablets and gastrointestinal disturbances. Patients often avoid discussing these issues with their primary care providers, and delays in addressing them can lead to reduced glycemic control. This article reviews the issues commonly responsible for poor adherence to metformin and presents strategies to improve compliance, including shared decision-making and the use of different metformin formulations, including liquid metformin.