Metformin in 2019

Abstract

Metformin is the first-line pharmacologic treatment for type 2 diabetes and the most commonly prescribed drug for this condition worldwide, either alone or in combination with insulin or other glucose-lowering therapies. Metformin is a biguanide, a drug class of herbal origin that has been widely used to treat diabetes since the 1950s., Two other biguanides were withdrawn from clinical use because they caused lactic acidosis. Metformin was also taken off the US market due to concerns over lactic acidosis, but it subsequently has been proven safe and effective in lowering glucose levels and was reintroduced in 1995. Optimal metformin use requires clear understanding of its effects, dosing, safety, and alternatives.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Flory reported receiving grants from AHRQ, a contract from PCORI, and personal fees from Eli Lilly and Genentech outside the submitted work. Dr Lipska reported receiving grants from NIA, support to develop and evaluate publicly reported quality measures from CMS, and personal fees from Health Services Advisory Group outside the submitted work.

Figures

Figure.. Suggested Starting Regimen for Metformin, Common Obstacles to Use, and Alternatives

Characterization of alternative medications is based on current American Diabetes Association guidelines for pharmacologic treatment of type 2 diabetes. eGFR indicates estimated glomerular filtration rate.