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Review
. 2020 Nov 27;13(12):427.
doi: 10.3390/ph13120427.

Where Does Metformin Stand in Modern Day Management of Type 2 Diabetes?

Ehtasham Ahmad  1   2 , Jack A Sargeant  1   2 , Francesco Zaccardi  1   2 , Kamlesh Khunti  1   3 , David R Webb  1   2 , Melanie J Davies  1   2
Affiliations
Review

Where Does Metformin Stand in Modern Day Management of Type 2 Diabetes?

Ehtasham Ahmad et al. Pharmaceuticals (Basel). .

Abstract

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.

Keywords: atherosclerotic cardiovascular disease; cardioprotection; cardiovascular outcomes; glucose-lowering therapy; metformin; type 2 diabetes.

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Conflict of interest statement

E.A. declares no conflict of interest. Outside the submitted work, the conflict of interest for rest of the co-authors is described here. J.A.S. has received a grant in support of an investigator-initiated trial from Astra Zeneca. F.Z. reports honoraria for lectures from Napp Pharmaceuticals and Boehringer Ingelheim. K.K. has acted as a consultant, speaker or received grants for investigator-initiated studies for Astra Zeneca, Novartis, Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Bayer, Berlin-Chemie AG/Menarini Group, Janssen, and Napp. D.R.W. has received honoraria as a speaker for Astra Zeneca, Sanofi-Aventis and Lilly, and received research funding support from Novo Nordisk. M.J.D. has acted as consultant, advisory board member and speaker for Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca and Janssen, an advisory board member for Servier and Gilead Sciences Ltd. and as a speaker for NAPP, Mitsubishi Tanabe Pharma Corporation and Takeda Pharmaceuticals International Inc. She has received grants in support of investigator and investigator-initiated trials from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, Astrazeneca and Janssen.

Figures

Figure 1
Figure 1
Summary diagram of individual sections.
See this image and copyright information in PMC

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