Where Does Metformin Stand in Modern Day Management of Type 2 Diabetes?
Ehtasham AhmadJack Alistair SargeantFrancesco ZaccardiKamlesh KhuntiDavid R WebbMelanie J DaviesPublished in: Pharmaceuticals (Basel, Switzerland) (2020)
Metformin is the most commonly used glucose-lowering therapy (GLT) worldwide and remains the first-line therapy for newly diagnosed individuals with type 2 diabetes (T2D) in management algorithms and guidelines after the UK Prospective Diabetes Study (UKPDS) showed cardiovascular mortality benefits in the overweight population using metformin. However, the improved Major Adverse Cardiovascular Events (MACE) realised in some of the recent large cardiovascular outcomes trials (CVOTs) using sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have challenged metformin's position as a first-line agent in the management of T2D. Many experts now advocate revising the existing treatment algorithms to target atherosclerotic cardiovascular disease (ASCVD) and improving glycaemic control as a secondary aim. In this review article, we will revisit the major cardiovascular outcome data for metformin and include a critique of the UKPDS data. We then review additional factors that might be pertinent to metformin's status as a first-line agent and finally answer key questions when considering metformin's role in the modern-day management of T2D.
Keyphrases
- type diabetes
- cardiovascular events
- cardiovascular disease
- machine learning
- coronary artery disease
- rheumatoid arthritis
- glycemic control
- big data
- emergency department
- weight loss
- insulin resistance
- risk factors
- adipose tissue
- systemic sclerosis
- clinical practice
- systemic lupus erythematosus
- ankylosing spondylitis
- data analysis
- combination therapy
- idiopathic pulmonary fibrosis
- adverse drug