Intended for healthcare professionals


Contraindications to the use of metformin

BMJ 2003; 326 doi: (Published 04 January 2003) Cite this as: BMJ 2003;326:4

Evidence suggests that it is time to amend the list

  1. G C Jones, consultant physician (,
  2. J P Macklin, senior house officer,
  3. W D Alexander, consultant physician
  1. Department of Diabetes, Gartnavel General Hospital, Glasgow G12 0YN
  2. Diabetes Centre, Western General Hospital, Edinburgh EH4 2XU

    According to the United Kingdom prospective diabetes study, patients with type 2 diabetes randomised to intensive treatment with metformin, sulphonylurea, or insulin had similar degrees of glycaemic control and significantly reduced microvascular end points.1 The study showed that the use of metformin in obese patients reduced cardiovascular events. The group treated with metformin had no hypoglycaemia and less weight gain. Treatment with metformin rather than diet alone produced a significant reduction in relative risk in all cause mortality (36%, P=0.011), diabetes related deaths (42%, P=0.017), any diabetes related end point (32%, P=0.0023), and myocardial infarction (39%, P=0.01). Metformin is the only oral hypoglycaemic agent proved to reduce cardiovascular risk and is now recognised as the treatment of choice in overweight patients with type 2 diabetes.

    Lactic acidosis associated with metformin is a rare condition with an estimated prevalence of one to five cases per 100 000.2 Although classically lactic acidosis associated with metformin has been thought of as lactic acidosis secondary …

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