Rol van metformine bij diabetesbehandeling

Two recent meta-analyses focused on the risk-benefit ratio of metformin in the treatment of type 2 diabetes mellitus. Both studies conclude that the risk-benefit ratio of metformin monotherapy or combined with insulin is uncertain. In our opinion, the interpretation of the known literature in these meta-analyses could be flawed. To ascertain the effects of metformin on cardiovascular end-points, a follow-up period of at least 8 years proved necessary. However, these meta-analyses included a number of studies with a limited follow-up period, thus impairing the possibility to make a proper comparison of the long-term effects of metformin. In addition, one meta-analysis based the weight of included studies on the number of events in all studies, including two safety studies, as opposed to the number of studied patients.

In our opinion, due to these concerns, the conclusions as drawn by the authors of these meta-analyses are insufficiently supported by the known literature. Although continuous monitoring of metformin on efficacy, side effects and risk-benefit ratio remains important, we are convinced that metformin remains an effective and safe first-line drug in patients with type 2 diabetes mellitus.

Conflict of interest: none declared. Financial support: none declared.