• 1.

    Crowley MJ, et al.. Clinical outcomes of metformin use in populations with chronic kidney disease, congestive heart failure, or chronic liver disease: A systematic review. Ann Intern Med 2017; 166:191200.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Chowdhury TA, et al.. Could metformin be used in patients with diabetes and advanced chronic kidney disease? Diabetes Obes Metab 2017; 19:156161.

  • 3.

    Lalau JD, et al.. Metformin and other antidiabetic agents in renal failure patients. Kidney Int 2015; 87:308322.

  • 4.

    Hung SC, et al.. Metformin use and mortality in patients with advanced chronic kidney disease: national, retrospective, observational, cohort study. Lancet Diabetes Endocrinol 2015; 3:605614.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Sanchez-Rangel E, Inzucchi SE. Metformin: Clinical use in type 2 diabetes. Diabetologia 2017; 60:15861593.

  • 6.

    Bailey CJ. Metformin: historical overview. Diabetologia. 2017; 60:15661576.

  • 7.

    An H, He L. Current understanding of metformin effect on the control of hyperglycemia in diabetes. J Endocrinol 2016; 228:R97R106.

  • 8.

    Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:837853.

    • Search Google Scholar
    • Export Citation
  • 9.

    Introduction: Standards of Medical Care in Diabetes–2019. Diabetes Care 2019; 42:S1S2.

  • 10.

    Holman RR, et al.. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359:15771589.

  • 11.

    Foretz M, et al.. Metformin: From mechanisms of action to therapies. Cell Metab 2014; 20:953966.

  • 12.

    Inzucchi SE, et al.. Metformin in patients with type 2 diabetes and kidney disease: A systematic review. JAMA 2014; 312:26682675.

  • 13.

    Eurich DT, et al.. Comparative safety and effectiveness of metformin in patients with diabetes mellitus and heart failure. Circ Heart Fail 2013; 6:395402.

    • Crossref
    • Search Google Scholar
    • Export Citation

Metformin: The Forgotten Agent

  • 1 Clarissa Jonas Diamantidis, MD, is a nephrologist affiliated with Duke University School of Medicine.
Restricted access

Effective, safe glycemic control is a global priority because uncontrolled diabetes contributes to a substantial burden of morbidity and mortality related to chronic kidney disease (CKD), ESKD, and cardiovascular disease (CVD) (1, 2). However, achieving this goal in patients with advanced kidney disease is complicated by evolving safety recommendations and contraindications to several existing antihyperglycemic medications when kidney function is substantially impaired (2). Amid robust evidence for inhibition of the renin-angiotensin system as the mainstay of managing diabetic kidney disease and growing attention to the significant cardiovascular, kidney, and survival benefits of sodium glucose

Save