Metformin Management in Patients with Uncontrolled Diabetes and Normal Renal Function

Assessment of Current Glycemic Control

• Patient has persistently elevated blood glucose readings, indicating poor glycemic control, with recent laboratory results showing fasting glucose levels confirming hyperglycemia, and current sliding scale insulin regimen alone is insufficient to maintain target glucose levels 1

Rationale for Metformin Initiation

• Metformin is recommended as first-line therapy for patients with Type 2 diabetes and eGFR ≥30 mL/min/1.73m², with a strong recommendation (1B) 1, 2

Monitoring Recommendations

• Regular monitoring of blood glucose levels to assess efficacy, and monitor renal function (eGFR) at least annually since patient's current eGFR is >60 mL/min/1.73m² 1, 2
• Monitor for vitamin B12 deficiency if treatment continues beyond 4 years 1, 3

Important Precautions

• Consider future addition of GLP-1 receptor agonist if glycemic targets are not achieved with metformin alone 1, 4