Metformin is the first-line pharmacotherapy for type 2 diabetes in most clinical guidelines combined with lifestyle modification as a co-intervention. According to the 2024 ADA Standards of Care patients with established cardiovascular disease heart failure or chronic kidney disease should receive a GLP-1 receptor agonist or SGLT2 inhibitor with proven cardiorenal benefit independently of metformin use.
See sources cited
- 2024 ADA Standards of Care in Diabetes
Metformin is the preferred initial pharmacologic agent for type 2 diabetes.
- NICE NG28: Type 2 diabetes in adults