Diabetes Metab J.  2020 Feb;44(1):3-10. 10.4093/dmj.2020.0004.

Metformin Treatment for Patients with Diabetes and Chronic Kidney Disease: A Korean Diabetes Association and Korean Society of Nephrology Consensus Statement

  • 1Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. drkwon@catholic.ac.kr
  • 3Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
  • 4Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
  • 5Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea. dongwonlee@pusan.ac.kr


The safety of metformin use for patients with type 2 diabetes mellitus (T2DM) and advanced kidney disease is controversial, and more recent guidelines have suggested that metformin be used cautiously in this group until more definitive evidence concerning its safety is available. The Korean Diabetes Association and the Korean Society of Nephrology have agreed on consensus statements concerning metformin use for patients with T2DM and renal dysfunction, particularly when these patients undergo imaging studies using iodinated contrast media (ICM). Metformin can be used safely when the estimated glomerular filtration rate (eGFR) is ≥45 mL/min/1.73 m². If the eGFR is between 30 and 44 mL/min/1.73 m², metformin treatment should not be started. If metformin is already in use, a daily dose of ≤1,000 mg is recommended. Metformin is contraindicated when the eGFR is <30 mL/min/1.73 m². Renal function should be evaluated prior to any ICM-related procedures. During procedures involving intravenous administration of ICM, metformin should be discontinued starting the day of the procedures and up to 48 hours post-procedures if the eGFR is <60 mL/min/1.73 m².


Contrast media; Diabetes mellitus; Metformin; Renal insufficiency

MeSH Terms

Administration, Intravenous
Contrast Media
Diabetes Mellitus
Diabetes Mellitus, Type 2
Glomerular Filtration Rate
Kidney Diseases
Renal Insufficiency
Renal Insufficiency, Chronic*
Contrast Media


  • Fig. 1 Secular trends in antidiabetic medication prescriptions in adults with type 2 diabetes mellitus, according to kidney function: (A) in patients with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2, (B) in patients with eGFR between 45 and 59 mL/min/1.73 m2, and (C) in patients with an eGFR between 30 and 44 mL/min/1.73 m2. SU, sulfonylurea; MFOM, metformin; GLN, glinide; TZD, thiazolidinedione; DPP-4i, dipeptidyl peptidase-4 inhibitor; α-Gi, α-glucosidase inhibitor.

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