Most international guidelines for the management of hyperglycemia in patients with type 2 diabetes suggest metformin as the initial preferred pharmacotherapy. Treatment with metformin is usually continued for as long as possible because the beneficial effects of this agent extend beyond glycemic control. However, metformin is contraindicated in patients with impaired renal function, and 20% to 40% of patients with type 2 diabetes are reported to incur impaired renal function (as indicated by a glomerular filtration rate [GFR] <60 mL/min).
Thus, questions are often raised about the initiation or continued use of metformin in type 2 diabetes patients who develop chronic kidney disease (CKD). Benefits and risks Metformin exerts insulin-dependent and insulin-independent effects that counter insulin resistance and reduce hyperglycemia without causing hypoglycemia and without causing weight…
