Use of Metformin and Cardiovascular Effects of New Classes of Glucose-Lowering Agents: A Meta-analysis of Cardiovascular Outcome Trials in Type 2 Diabetes

Over the last two decades, the large majority of clinical guidelines on the treatment of hyperglycaemia in subjects with type 2 diabetes have suggested metformin as the first-line glucose-lowering treatment alongside lifestyle changes to reach personalized glycemictargets. Recently, the European Society of Cardiology (ESC) recommended using glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 inhibitors(SGLT-2is) as first line glucose-lowering therapy in subjects with type 2 diabetes at high or very high risk of cardiovascular disease (CVD), ahead of metformin treatment, to reduce cardiovascular events.