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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 …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.