Authors conclude that the results support cautious use of metformin in patients with type 2 diabetes and eGFR of at least 30 mL/min/1.73 m2.
A related editorial discusses this research. It postulates that when presented with a balanced risk-benefit discussion on the initiation of metformin or empagliflozin or liraglutide (both considered safe in renal impairment in the context of clinical trials) many if not most patients will choose metformin as the first-line drug in the setting of chronic kidney disease. However, there is clearly a role for the newer agents, particularly for those patients who need more than 1 agent to treat their diabetes, or for those who are unable to tolerate metformin, or who are no longer appropriate candidates for the medication. The challenge is for clinicians to present clear information to guide patient decisions, based on each patient’s clinical circumstances and preferences.
Current NICE guidance for type 2 diabetes (NG28) recommends that in adults with type 2 diabetes, the dose of metformin should be reviewed if the eGFR is <45mL/min/1.73m2