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Minimizing Side Effects

Aug 26, 2017

Your patient has been newly diagnosed with type 2 diabetes (A1C 7.7%) and you have prescribed metformin. Metformin should be titrated to minimize which side effect?


Correct Answer is: D. Gastrointestinal side effects

Educational Critique: If well tolerated and not contraindicated, metformin is considered the preferred first-line treatment for TYPE 2 DIABETES. While generally well tolerated, gastrointestinal side effects are considered a common problem unless metformin is titrated.


  1. Begin with low-dose metformin (500 mg) taken once or twice per day with meals (breakfast and/or dinner) or 850 mg once per day.
  2. After 5–7 days, if gastrointestinal side effects have not occurred, advance dose to 850, or two 500 mg tablets, twice per day (medication to be taken before breakfast and/or dinner).
  3. If gastrointestinal side effects appear as doses advanced, decrease to previous lower dose and try to advance the dose at a later time.
  4. The maximum effective dose can be up to 1,000 mg twice per day but is often 850 mg twice per day. Modestly greater effectiveness has been observed with doses up to about 2,500 mg/day. Gastrointestinal side effects may limit the dose that can be used.
  5. Based on cost considerations, generic metformin is the ?rst choice of therapy. A longer-acting formulation is available in some countries and can be given once per day.

Above is a transcript of the latest statement published on Diabetes Care about the titration of metformin in the medical management of hyperglycemia in type 2 diabetes.