Metformin is the most widely used glucose lowering drug worldwide in the treatment of patients with type 2 diabetes, since we have experience with this drug for more than 60 years about the efficacy and safety. Metformin is very effective in HbA1c lowering associated with some weight loss, but does not increase risk for hypoglycemia. At the moment all guidelines in the world recommend to use metformin in monotherapy in patients with newly diagnosed diabetes or in combination with other antidiabetic drugs with documented CV (and renal) benefit in cardiovascular outcome trials (CVOT). Although a randomized placebo controlled CVOT with metformin is lacking, many observational studies in patients with coronary heart disease, heart failure and chronic kidney disease have demonstrated consistent beneficial effects. A recent metanalysis of 26 observational studies including 815 839 patients showed that metformin use was associated with a significantly lower rate of all-cause mortality (HR: 0.74; 95% CI: 0.68-0.81). Whether this very consistent reduction of all-cause mortality is related to the incidence/outcome of several cancers has still to be investigated. In the future early combination therapy of metformin e.g. with SGLT-2 inhibitors should be more often used.

中文翻译：

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今天是二甲双胍的正确地方。

二甲双胍是全世界治疗2型糖尿病患者使用最广泛的降糖药物，因为我们在这种药物的疗效和安全性方面已有60多年的经验。二甲双胍在降低HbA1c以及减轻体重方面非常有效，但不会增加低血糖的风险。目前，世界上所有指南均建议在新诊断的糖尿病患者中或在心血管结局试验（CVOT）中与已证明CV（和肾脏）获益的其他抗糖尿病药物联合使用二甲双胍进行单药治疗。尽管缺乏用二甲双胍进行安慰剂控制的随机CVOT，但对冠心病，心力衰竭和慢性肾脏病患者的许多观察性研究均显示出一致的有益作用。最近对包括815 839例患者在内的26项观察性研究的荟萃分析表明，使用二甲双胍与全因死亡率显着降低有关（HR：0.74； 95％CI：0.68-0.81）。这种全因死亡率的非常一致的降低是否与几种癌症的发生/结果相关尚待研究。在将来，应更经常使用二甲双胍的早期联合疗法，例如与SGLT-2抑制剂的联合疗法。