The Metformin Dilemma A 54 year old gentleman with type 2 diabetes mellitus and hypertension since 18 years came for the consultation in diabetes clinic. He was asymptomatic. The consultant managing his diabetes was happy to see the first page of lab reports FPG- 108 mg/dl, Postmeal PG- 148 mg/dl and HbA1c – 6.6 %. The patient was taking Metformin 850 mg and Glimepiride 1 mg twice a day. Blood glucose levels and HbA1c were in the target range without symptoms of hypoglycemia. He turned the page to see serum creatinine report, and it was 2.1 mg/dl.
One year back it had been 1.4 mg/dl. His present eGFR using the CKD-EPI formula was 34.6 mL/min/1.73m². So now there was a big question in front of the consultant whether to continue Metformin in the same dose as the glucose levels are adequately controlled, or to reduce the dose, or to stop Metformin in view of high Sr. Creatinine? Let us…
