Diabetes, Metabolic Syndrome and Obesity (Mar 2025)

Metformin for the Treatment of Type 2 Diabetes in Asian Adults: A Systematic Review

  • Somasundaram N,
  • Kalra S,
  • Shrestha D,
  • Raza SA,
  • Bhattacharya S,
  • Sahay R,
  • Afsana F,
  • Naseri MW,
  • Dhakal GP,
  • Suastika K,
  • Ratnasingam J,
  • Latheef AA

Journal volume & issue
Vol. Volume 18
pp. 873 – 904

Abstract

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Noel Somasundaram,1 Sanjay Kalra,2 Dina Shrestha,3 S Abbas Raza,4 Saptarshi Bhattacharya,5 Rakesh Sahay,6 Faria Afsana,7 Mohammad Wali Naseri,8 Guru Prasad Dhakal,9 Ketut Suastika,10 Jeyakantha Ratnasingam,11 Ali Abdulla Latheef12 1Diabetes and Hormone Centre, Colombo, Sri Lanka; 2Bharti Research Institute of Diabetes & Endocrinology (BRIDE), Karnal, Haryana, India; 3Hospital for Advanced Medicine and Surgery (HAMS), Kathmandu & Norvic International Hospital and Medical College, Kathmandu, Nepal; 4Shaukat Khanum Cancer Hospital & Research Center and National Hospital in Lahore, Lahore, Pakistan; 5Indraprastha Apollo Hospitals, NH-19, Delhi, India; 6Endocrinology & Diabetology, Aster Prime, Hyderabad, India; 7Department of Endocrinology at Birdem General Hospital & Ibrahim Medical College, Dhaka, Bangladesh; 8Endocrinology, Metabolism and Diabetes, Kabul University of Medical Sciences, Kabul, Afghanistan; 9Department of Medicine, Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Science of Bhutan, Menkhang Lam, Thimphu, Bhutan; 10Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia; 11Endocrine Unit, Department of Medicine, University Malaya, Kuala Lumpur, Malaysia; 12Physician and Indira Gandhi Hospital, Male, IndiaCorrespondence: Noel Somasundaram, Consultant Endocrinologist, Diabetes and Hormone Centre, Colombo, Sri Lanka, Email [email protected]: Metformin is a cheap, orally administered, guideline recommended glucose-lowering drug (GLD), initiated as monotherapy in treatment naïve newly diagnosed type 2 diabetes (T2D), and in combination with other GLDs in T2D not controlled on metformin. The unique Asian T2D phenotype that is markedly different than Western population, and warrants T2D treatment approaches unique to the Asian population. However, the bulk of metformin literature is from Western population and may not be generalizable for Asians. The systematic review evaluated the efficacy and safety of metformin monotherapy and combination therapy in Asians. Literature on other GLDs recommended by the 2023 American Diabetes Association guidelines as add-on therapy to metformin were included from Asia. The systematic review concluded that metformin is effective and safe for long-term T2D control of T2D in Asians. Metformin monotherapy may be initiated and continued in treatment naïve Asian patients with T2D and/or obesity if the monotherapy is adequate for achieving glycemic control. Other GLDs may be added for better glycemic control for those who fail on monotherapy. Patients inadequately controlled on another first-line GLD can achieve glycemic control and target HbA1c of < 7% by adding metformin in a once daily dose. The use of metformin reduces the risk of hypoglycemia, and its gastrointestinal side effects are mild and manageable in Asians.Keywords: metformin, guideline directed, type 2 diabetes, Asians

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