NICE guidance - metformin in type 2 diabetes
The usual first line therapy in type 2 diabetes management is, in general, modified release metformin plus an SGLT2 inhibitor.
Introducing medicines in a stepwise manner
Medicines should be introduced in a stepwise manner, checking for tolerability and effectiveness of each medicine.
When an adult with type 2 diabetes starts initial therapy with metformin and one or more other medicines:
- introduce the medicines one at a time, starting with metformin and checking tolerability
- if using an SGLT-2 inhibitor, start this as soon as metformin is at the maximum tolerated dose
Reviewing metformin
For adults with type 2 diabetes who are already taking standard-release metformin:
- continue with this treatment or
- switch to modified-release metformin if standard-release metformin is not tolerated or if this is the person's preference
- metformin is contraindicated if a patient has an eGFR of less than 30 mL/min/1.73 m2
For detailed guidance then consult the full guideline.
General guidance re: renal function and metformin
- eGFR ≥45 mL/min/1.73 : safe to use
- eGFR 30–44 mL/min/1.73 : review dose of metformin; consider reducing to a maximum daily dose of 1,000 mg
- eGFR <30 mL/min/1.73 : stop treatment with metformin
- renal risk: Use with caution if there is a risk of rapid deterioration in renal function (e.g., dehydration, infection).
Reference:
Related pages
Create an account to add page annotations
Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.