Metformin

Quality prescribing strategy for type 2 diabetes mellitus: a guide for improvement
Scottish Government Effective Prescribing & Therapeutics Division
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See section on metformin for further information.

Metformin remains first line treatment for the majority of patients. This NTI should have a high percentage for this indicator.

  • Metformin should be prescribed first line unless there is a contraindication (eGFR<30ml/min, or lactic acidosis) or true intolerance (which can be reduced by prescribing sustained release preparations).
  • There should be a high percentage of patients who are prescribed metformin.

 

Metformin as percentage of all people prescribed an anti-diabetic drug

Action required by boards/clusters/practices

  • NHS Boards/MCNs/Prescribing groups should review their data in comparison to other boards to determine areas of unwarranted variation.
  • GP clusters and practices can review their data with other practices or cluster regions to show variation in their prescribing practices.
  • Identify missing individuals: Clusters and practices should identify those who are suitable for metformin but not currently prescribed this. Prioritise younger individuals for more aggressive treatment.
  • Safety consideration: Ensure appropriate dosage in line with renal function, e.g. metformin dose should be reduced if eGFR falls below 45 and stopped if eGFR<30.
  • Medication should be reviewed in line with the 7 Steps process.