| Summary: | Metformin, together with lifestyle intervention, is considered first-line treatment for glycemic management in people with type 2 diabetes. Despite this widespread use, one of the areas of longstanding debate has been whether metformin can be used safely in those with chronic kidney disease (CKD). The concern is the possibility of an increased risk for lactic acidosis resulting from metformin accumulation in those with renal impairment. Metformin associated lactic acidosis (MALA) is a rare complication of long-term metformin therapy and the risk is increased in patients who have concomitant risk factors like cardiac, renal or liver failure. This condition is associated with high mortality and morbidity.
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