二甲双胍临床应用专家共识（2023年版）

中华内科杂志2023年6月第62卷第6期Chin J Intem Med.Jne2023.Val.62.No.6·619·标准与讨论·二甲双胍临床应用专家共识(2023年版)《二甲双胍临床应用专家共识》更新专家组通信作者：母义明，解放军总医院第一医学中心内分泌科，北京100853，Email:muyiming(@301 hospital..com.cn;纪立农，北京大学人民医院内分泌科，北京100044，Email:jiln@bimu.edu.cn【摘要】二甲双胍具有良好的降糖作用以及降糖之外的多种益处，可与其他任何降糖药物联用，且具有良好的成本效益。在无胰高糖素样肽-1受体激动剂(GP-1RA)或钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)心肾保护的强适应证的情况下，二甲双胍应作为新诊断2型糖尿病控制高血糖的一线用药和降糖药物联合治疗的基础用药。二甲双胍本身不增加肝、肾功能损害的风险，已出现肾功能不全的患者应根据估算的肾小球滤过率水平调整二甲双胍的剂量。正确使用二甲双肌不增加乳酸性酸中毒风险。长期使用二甲双胍与维生素B2水平的下降有关，维生素B摄入或吸收不足的患者应定期监测并适当补充维生素B2。鉴于二甲双胍相关基础和临床研究取得的一些新进展，共识更新专家组在《二甲双胍临床应用专家共识(2018年版)》的基础上进行了更新，形成本共识意见。【关键词】二甲双胍；糖尿病，2型；临床应用；共识Chinese expert consensus on metformin in clinical practice:2023 updateExpert Group for Updating Chinese Expert Consensus on Metformin in Clinical PracticeCorresponding authors:Mu Yiming,Department of Endocrinology,First Medical Center of PLA GeneralHospital,Beijing 100853,China,Email:muyiming@301hospital.com.cn;Ji Linong,Department ofEndocrinology,Peking University People's Hospital,Beijing 100044,China,Email:jiln@bjmu.edu.cnAbstract)Metformin has robust glucose-lowering effects and multiple benefits beyondhypoglycemic effects.It can also be used in combination with various hypoglycemic drugs and is costeffective.In the absence of the strong indications of glucagon like peptide-1 receptor agonist(GLP-1RA)or sodium glucose cotransporter 2 inhibitor (SGLT2i)for cardiorenal protection,metformin should be used as the first-line pharmacological treatment for newly diagnosed type 2diabetes and the basic drug for the combined treatment of hypoglycemic drugs.Metformin does notincrease the risk of liver and kidney function damage,but patients with renal dysfunction shouldadjust the dosage of metformin based on estimated glomerular filtration rate (eGFR)levels.Moreover,the correct use of metformin does not increase the risk of lactic acidosis.Becauselong-term use of metformin is associated with a decrease in vitamin B.levels,patients withinsufficient intake or absorption of vitamin B should be regularly monitored and appropriatelysupplemented with vitamin B..In view of the new progress made in the basic and clinical researchrelated to metformin,the consensus updating expert group updated the consensus on the basis ofthe Expert Consensus on the Clinical Application of Metformin (2018 Edition).Key words Metformin;Diabetes mellitus,type 2;Clinical practice;Consensus二甲双胍最早在1957年正式应用于临床治疗二甲双胍具有良好的疗效、安全性、卫生经济学证糖尿病，在我国也已有30余年的临床应用经验。据以及心血管保护相关的证据，并且具有多种降糖D01:10.3760/cma.i.cnl12138-20230305-00131收稿日期2023-03-05本文编辑赵景辉引用本文：《二甲双胍临床应用专家共识》更新专家组.二甲双胍临床应用专家共识(2023年版)中华内科杂志，2023,626619-630.D0I:10.3760/cmaj.cm112138-20230305-00131.