1, 3 Professional societies support metformin use at estimated glomerular filtration rates (eGFRs), a better measure of renal function than the serum creatinine level, of 45 or even 30 mL/min (which typically equates to a serum creatinine level of about 2 mg/dL). This contraindication has been widely criticized as overly conservative. The drug carries a contraindication against use when serum creatinine levels exceed 1.4 mg/dL in women or 1.5 mg/dL in men based on fears about lactic acidosis (to convert creatinine level to micromoles per liter, multiply by 88.4). One likely explanation for this shortfall is the avoidance of metformin use in renal insufficiency. Even in patients who are taking other oral T2DM drugs, only about 70% use metformin. Despite this, half of the patients with T2DM do not take metformin. Metformin hydrochloride is the first-line drug for type 2 diabetes mellitus (T2DM) 1 and is the only oral diabetes drug with evidence for improved cardiovascular outcomes. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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