Letters Diabetes control in older people

The usefulness of metformin for diabetes control in older people

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3077 (Published 15 May 2013) Cite this as: BMJ 2013;346:f3077
  1. Richard Quinton, consultant and senior lecturer in endocrinology1
  1. 1Institute for Genetic Medicine, University of Newcastle on Tyne, Endocrine Unit, Royal Victoria Infirmary, Newcastle NE1 4LP, UK
  1. richard.quinton{at}ncl.ac.uk

McLaren and colleagues argue pragmatically and coherently against aggressive target driven strategies for lowering glycated haemoglobin (HbA1c) in older people.1 The one exception, however, is patients with normal renal function who are receiving metformin monotherapy.

In these patients (as with patients treated with diet alone), there is no risk of hypoglycaemia or weight gain with lower HbA1c values, or any of the concerns about potential hepatotoxity or pancreatic toxicity that apply to newer agents.2

Thus, the metformin dose is titrated up gradually only to minimise gastrointestinal side effects and does not need to be adjusted according to HbA1c.3

Indeed, full dose metformin has long been used to treat normoglycaemic women with polycystic ovary syndrome,4 and it will probably soon enter the therapeutic armamentarium for non-alcoholic fatty liver disease.5


Cite this as: BMJ 2013;346:f3077


  • Competing interests: None declared.