Drug treatment of type 2 diabetes mellitus in patients for whom metformin is contraindicated

Figures & data

Table 1 Recommended precautions for and contraindications to use of metformin based on renal function

Source	Renal criteria
American Association of Clinical Endocrinology^Citation4	Review use with eGFR 30–44
	Discontinue use with eGFR <30
National Institute for Health and Clinical Excellence^Citation2	Review dosage with eGFR <45
	Discontinue use with eGFR <30
International Diabetes Federation^Citation1	Use with caution if eGFR <45
FDA-approved drug label^Citation71	Contraindicated with serum creatinine ≥133 mmol/L (1.5 mg/dL) in men, 124 mmol/L (1.4 mg/dL) in women, or with “abnormal creatinine clearance”
UK MHRA^Citation72	Contraindicated with creatinine clearance <60 mL per minute

Abbreviations: eGFR, estimated glomerular filtration rate (in mL/min/1.73 m²); FDA, US Food and Drug Administration; MHRA, Medicines and Healthcare Products Regulatory Agency.

Table 2 Factors to consider in selection of a diabetes agent

Baseline A1c

Hyperglycemic issue (fasting, post-prandial, both)

Existing comorbidities

Risk of hypoglycemic complications

Injection preference

Adverse effect profile

Patient preference

Cost

Pleiotropic effects (eg, lipids, blood pressure)

Effect on pathophysiology of type 2 diabetes mellitus

Necessity for weight loss

Garber AJ Abrahamson MJ Barzilay JI American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement Endocr Pract 2013 19 Suppl 2 1 48 24129260

 PubMed Web of Science ®Google Scholar

National Institute for Health and Clinical Excellence Type 2 diabetes: The management of type 2 diabetes (NICE clinical guideline 87) Available from: http://www.nice.org.uk/guidance/CG87 Accessed August 15, 2013

 Google Scholar

International Diabetes Federation Global guideline for type 2 diabetes Available from: http://www.idf.org/global-guideline-type-2-diabetes-2012 Accessed September 5, 2013

 Google Scholar

Glucophage (metformin hydrochloride tablets) FDA-approved label Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020357s031,021202s016lbl.pdf Accessed September 25, 2013

 Google Scholar

United Kingdom Medicines and Healthcare Products Regulatory Agency Metformin Summary of Product Characteristics Available from: http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1376454233492.pdf Accessed September 25, 2013

 Google Scholar