Metformin and vascular protection: a diabetologist's view

The diabetologist's short-term priority is often to gain rapid control of severe and symptomatic hyperglycaemia, with the longer term objective of preventing or delaying the onset of the debilitating and life-threatening complications that result from continued poor glycaemic control. Indeed, guidelines for the management of type 2 diabetes are centred firmly on measures of glycaemic control, based on evidence from the landmark UK Prospective Diabetes Study and Diabetes Control and Complications Trial. Nevertheless, we must remember that most type 2 diabetic patients ultimately die from a cardiovascular cause. A comprehensive approach is needed, where effective control of blood glucose takes place alongside aggressive management of cardiovascular risk factors. A substantial database of clinical evidence, including the ground-breaking UK Prospective Diabetes Study, underpins the place of metformin both as an effective oral antihyperglycaemic agent and for reducing the risk of morbid cardiovascular events.