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Type 2 diabetes mellitus (T2DM) has an ever-growing prevalence worldwide, affecting 1 in 11 adults. It
continues to significantly impact patients in terms of morbidity and mortality, in addition to impairing quality of life while
adding to the spiralling healthcare costs.
Metformin was first used over half a century ago, and for the past two decades it has been considered first line oral
therapy to treat patients with T2DM, in whom lifestyle measures failed to improve glycaemic control. Early landmark
studies supported a glycaemic benefit with metformin use with a relatively safe adverse effect profile, particularly with
avoidance of hypoglycaemia. Moreover, studies have indicated other potential beneficial role for metformin on organs
typically affected by diabetes complications.
However, more recently, with the discovery of newer hypoglycaemic agents and the wealth of data provided by large
scale cardiovascular safety studies, algorithms for the treatment of patients with T2DM have become increasingly
complex. Indeed, recent guidelines challenge current thinking and advocate the use of agents other than metformin as first
line agents in those with higher cardiovascular risk, potentially unseating metformin from its long-held throne.
This narrative review aims to summarize the background and origins of metformin, assess role in the current management
of patients with T2DM, highlighting clinical efficacy and safety profile of this agent. Also, the position of metformin in
the clinical algorithms is discussed in light of most recent evidence in the field, helping with an ever-increasing shift
towards individualized patient care to maximize benefits and minimize risks.
Treating Arterial Stiffness in Metabolic Syndrome and Type 2 Diabetes Mellitus
