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Systematic review
Metformin should not be contraindicated in patients with type 2 diabetes and mild to moderate renal impairment
  1. André J Scheen
  1. Division of Diabetes, Nutrition and Metabolic Disorders, University of Liège, Liège, UK
  1. Correspondence to Dr André J Scheen, Division of Diabetes, Nutrition and Metabolic Disorders, University of Liège, CHU Liège, Sart Tilman (B35), Liège B-4000, Belgium; andre.scheen{at}chu.ulg.ac.be

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Metformin is considered the best initial treatment to lower glucose concentrations in patients with type 2 diabetes.1 However, as it is cleared by the kidneys, it may accumulate when renal function decreases, with the potential for exposure-dependent toxicity that could precipitate lactate accumulation. Chronic kidney disease (CKD) is a frequent scenario in type 2 diabetes, a condition that may challenge the use of many glucose-lowering agents.2 There is increasing evidence …

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