Metformin, one of the most widely used oral hypoglycemic agents in the world, plays an important role in treating type 2 diabetes for decades, and it has been recommended as a first-line drug in diabetes guidelines around the world because of the good efficacy and safety for monotherapy and combination therapy, evidence of health economic benefits, and definite clinical evidence in the prevention of cardiovascular complications.
Metformin has been clinically applied for more than 30 years in China. However, some clinicians and patients still have misunderstandings about the use of metformin, which makes some patients, that could formally benefit from metformin therapy miss treatment opportunities. Therefore, the Chinese Expert Consensus Statement on Metformin in Clinical Practice was jointly formed by endocrinologists and pharmaceutical experts with the aim of guiding clinicians and patients to correctly understand and rationally use Metformin (Supplementary file).
By using a question-and-answer format, this consensus addressed the clinical status and initial treatment opportunity, mechanism, drug dose and clinical efficacy, drug use in special diabetic populations, safety, effects on cardiovascular system, which included six modules and 17 main recommendations about combination medication of Metformin. Main recommendations are presented in Table 1.
Table 1.
Main recommendations of metformin therapy.
Recommendations were formulated using the Class of Recommendation (COR) and Level of Evidence (LOE) system by the American College of Cardiology and American Heart Association.[1] This system provides a transparent mechanism to judge benefit relative to risk using a classification scheme (I, IIa, IIb, and III), supported by evidence quality and quantity using an LOE rating (A, B-Randomized, B-Non-randomized, C-Limited data, C-Expert opinion, all recommendations are listed with a COR and LOE rating.
The Expert Group members:
Yi-Ming Mu1, Li-Nong Ji2, Guang Ning3, Guang-Wei Li4, Zhong-Yan Shan5, Yan Li6, Zi-Lin Sun7, Yan-Bing Li8, Jia-Jun Zhao9, Wei-Qing Wang2, Da-Long Zhu10, Tian-Pei Hong11, Nan-Wei Tong12, Zhi-Guang Zhou13, Da-Jin Zou14, Chao Liu15, Qiang Li16, Li-Xin Guo17, Yong-De Peng18, Lu-Lu Chen19, Xin-Hua Xiao20, Xue-Feng Yu21, You-Min Wang22, Qiu-He Ji23, Qi-Fu Li24, Chun-Lin Li25, Quan-Min Li26, Li-Xin Shi27, Yi-Ming Li28, Yong-Quan Shi29, Suo-Di Zhai30, Zhi-Gang Zhao31, Wan-Hua Yang32, Li-Wei Ji33, Rong-Sheng Zhao30, Jiu-Hong Wu34
1Department of Endocrinology, People's Liberation Army General Hospital, Beijing 100853, China
2Department of Endocrinology, Peking University People's Hospital, Beijing 100044, China
3Department of Endocrinology and Metabolism, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
4Department of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
5Department of Endocrinology, the First Hospital of China Medical University, Shenyang, Liaoning 110001, China
6Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
7Department of Endocrinology, Zhongda Hospital Southeast University, Nanjing, Jiangsu 210009, China
8Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
9Department of Endocrinology, Shandong Provincial Hospital, Jinan, Shandong 250021, China
10Department of Endocrinology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, China
11Department of Endocrinology, Peking University Third Hospital, Beijing 100191, China
12Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
13Department of Endocrinology and Metabolism, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
14Department of Endocrinology, Department of Endocrinology, Changhai Hospital, Shanghai 200433, China
15Department of Endocrinology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu 210028, China
16Department of Endocrinology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, China
17Department of Endocrinology, Beijing Hospital, Beijing 100730, China
18Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai 200080, China
19Department of Endocrinology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
20Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
21Department of Endocrinology, Tongji Medical College, Huazhong University of Science &Technology, Wuhan, Hubei 430030, China
22Department of Endocrinology, the First Affiliated Hospital of Medical University of Anhui, Hefei, Anhui 230022, China
23Department of Endocrinology, Xijing Hospital, Xi’an, Shaanxi 710032, China
24Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 404000, China
25Department of Geriatric Endocrinology, People's Liberation Army General Hospital, Beijing 100853, China
26Department of Endocrinology, Rocket People's Liberation Army General Hospital, Beijing 100088, China
27Department of Endocrinology and Metabolism, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
28Department of Endocrinology, Shanghai Huashan Hospital, Shanghai 200040, China
29Department of Endocrinology, Shanghai Changzheng Hospital, Shanghai 200433, China
30Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
31Department of Pharmacy, Beijing Tiantan Hospital, Beijing 100050, China
32Department of Pharmacy, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
33Department of Pharmacy, Beijing Hospital, Beijing 100730, China
34Department of Pharmacy, Special Medical Center of Strategic Support Forces, Beijing 100101, China.
Conflicts of Interest
None.
Supplementary Material
Footnotes
How to cite this article: Expert Group of Metformin in Clinical Practice. Chinese expert consensus statement on metformin in clinical practice. Chin Med J 2020;133:1445–1447. doi: 10.1097/CM9.0000000000000883
Contributor Information
Collaborators: Expert Group of Metformin in Clinical Practice and Expert Group of Metformin in Clinical Practice
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