Inclusion Criteria:  BMI 25 kg/m2 or above (23 or above if Asian American woman) History of gestational diabetes mellitus History of prediabetes in prior 36 months defined by either 1) most recent HbA1c 5.7-6.4% or 2) most recent FPG 100-125 mg/dL or 3) prior diabetes diagnostic codes + abnormal labs Patient at UCLA or Intermountain Healthcare Systems with provider visit or labs in prior 12 months  Exclusion Criteria:  Delivery within prior 12 months History of diabetes (i.e., prior HbA1c 6.5% or above, or 2 or more fasting plasma glucose 125 or above, or prior diagnostic code) Use of an anti-glycemic medication in prior 12 months Last available glomerular filtration rate (eGFR) <45 ml/min BMI >60 kg/m2 Bariatric surgery with prior 12 months Active eating disorder Currently pregnant or planning to get pregnant in the next 12-24 months Currently breastfeeding Completed a prediabetes SDM consult in past Currently enrolled in a CDC recognized Diabetes Prevention Program (DPP) Inability or concerns about doing >150 minutes of physical activity per week History of metformin intolerance Non-English primary language