A friend told Huazi that he had suffered from type 2 diabetes for more than ten years and had been using metformin, but he knew many new diabetics and metformin was no longer included in their treatment plans. Why was that? Huazi told him that metformin had declined in status in the treatment of type 2 diabetes.

The current treatment drugs mainly use GLP-1 receptor agonists and SGLT-2 inhibitors that have good cardiovascular protection. Metformin is used as a "supporting role" in combination with the above-mentioned hypoglycemic drugs, rather than as the main treatment drug. However, some elderly patients with type 2 diabetes are still using metformin because of their medication habits.

1. Blood sugar reduction and cardiovascular protection

High blood sugar can cause damage to the body, mainly heart and kidney damage. Traditional diabetes treatment focuses on lowering blood sugar , but now diabetes treatment focuses on protecting the heart and kidneys while lowering blood sugar .

In relevant clinical studies, GLP-1 receptor agonists (exenatide, liraglutide, dulaglutide, semaglutide, etc.) and SGLT-2 inhibitors (dapagliflozin, empagliflozin, canagliflozin, ertogliflozin, etc.) have good cardiorenal protective effects while lowering blood sugar and reducing weight.

Although metformin has a good blood sugar lowering effect and has been used clinically for more than 60 years, it is slightly inferior in terms of evidence for cardiorenal protection , so its clinical status has declined and it has given up the "godly throne" of blood sugar lowering drugs.

2. Medication options for type 2 diabetes

For patients with type 2 diabetes who have concurrent cardiorenal damage such as atherosclerosis, heart failure, and renal insufficiency, GLP-1 receptor agonists or SGLT-2 inhibitors are now recommended as first-line treatment drugs.

For overweight type 2 diabetics who do not have concomitant heart and kidney damage, GLP-1 receptor agonists and SGLT-2 inhibitors are also recommended for treatment. This is because both of them have a clear weight loss effect while lowering blood sugar . Although metformin also has a weight loss effect, it is not significant. It is more due to gastrointestinal irritation and appetite loss.

People with type 2 diabetes who do not have concomitant heart and kidney damage and are not overweight can use metformin for treatment. People with prediabetes such as impaired fasting glucose and impaired glucose tolerance can also use metformin to delay the onset of type 2 diabetes.

3. Metformin is an important "supporting role"

In the treatment of type 2 diabetes, a considerable number of people cannot effectively control blood sugar using a single drug, and their glycosylated hemoglobin (HbA1c) cannot meet the standard, requiring the combined use of two or more glucose-lowering drugs .

Metformin has a good blood sugar lowering effect, is low in price, is not prone to causing hypoglycemia, and is highly safe for the liver and kidneys. It remains an excellent blood sugar lowering drug and an important "supporting role" in the combination of blood sugar lowering drugs , playing an indispensable and important role.

Metformin can be used in combination with GLP-1 receptor agonists, SGLT-2 inhibitors, DPP-4 inhibitors, α-glucosidase inhibitors, insulin sensitizers, glucokinase agonists, insulin secretagogues, insulin and other drugs to enhance blood sugar control while having better safety.

In summary, in the treatment of type 2 diabetes, the status of metformin has declined because various new drugs can not only lower blood sugar, but also have good cardiorenal protection. However, metformin is still a cheap and high-quality hypoglycemic drug, and has not left the stage of hypoglycemic treatment. It can be used as an important "supporting role" in combination with other hypoglycemic drugs.

Drugs must be used under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.