What ADA/EASD consensus guideline has to say about metformin for hyperglycemia management in type 2 diabetes

USA: Metformin has high effectiveness in lowering HbA1c, minimal risk of hypoglycemia when used as monotherapy, good safety profile, low cost, and weight neutrality with the potential for modest weight loss, according to a statement from a recently released consensus update. Due to these characteristics of metformin, metformin remains the agent of choice is most diabetics.
The consensus update on hyperglycemia management in type 2 diabetes was released by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). The statement was presented at the 58th EASD Annual Meeting in Stockholm, Sweden, and subsequently got published in the journals Diabetologia by EASD and Diabetes Care by ADA.
The consensus also cautioned against metformin use in people with an eGFR <30 ml/min per 1.73 m2 and suggests considering dose reduction when the eGFR is <45 ml/min per 1.73 m2. Further, the document stated that the use of metformin may lead to lower concentrations of serum vitamin B12 and worsening neuropathy symptoms; therefore, the authors recommend supplementation and periodic monitoring in case of deficiency, particularly in anemic patients or those with neuropathy.
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