Metformin in Diabetic Kidney Disease

Immediate release:

 • Initial 500 mg or 850 mg once daily

 • Titrate upwards by 50 mg/d or 850 mg/d every 7 days until maximum dose

eGFR 30-44: Initiate at half the dose and titrate upwards to half of maximum recommended dose

eGFR < 30: Stop metformin; do not initiate metformin

Monitor vitamin B12 annually if on metformin for more than 4 years or at risk of vitamin B12 deficiency

Monitor kidney function at least every 3-6 months



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