1. Metformin Use in Chronic Kidney Disease
Table: Suggested use of metformin in patients with chronic kidney disease according to stages of kidney disease
Metformin Use in Chronic Kidney Disease
CKD Stage
eGFR
( ml/min/1.73 m2)
Metformin Dose
Precautions and frequency of renal function monitoring 1
>90
Maximum dose†
Annual * # 2
60-89
Annual * # 3a
45-59
3-6 months * # 3b
30-44
Half the maximum dose
Every 3 months *
Avoid if unexpected change in eGFR is anticipated,e.g heart failure, diuretic use or other medications which may affect eGFR 4
15-29
None * 5
<15
† Maximum dose of metformin is generally 2000 mg per day
* Apply standard precautions including withholding metformin therapy during episodes of dehydration ,e.g. vomiting ,gastroenteritis and before administration of contrast media.
# More frequent monitoring can be applied as dictated by clinical setting.

2. 7/5/2018 8:34 AM
 HBA1c (%)
Protocol-permitted insulin dose adjustments in both arms of these trials
Figure 1: Magnitude of HBA1c lowering with metformin monotherapy, add-on to oral therapy or add-on to insulin: meta-analysis of 35 Trials of at least 12 weeks duration (drawn from data presented by ….. Hirst JA et al. Reference …..)

3. Figure 2: GI tolerability whilst on metformin XR in patients previously intolerant to immediate release formulation of metformin in five diabetes centres. Drawn from data presented by Feher et al. et al. (ref …) and Ashawesh, K et al. (ref …)