Metformin is widely used for treating patients with type 2 diabetes mellitus. Recently, new options of metformin therapy were highlighted by several clinical observations. Accordingly, the benefit of metformin for treating patients with type 1 diabetes was documented (as an add-on therapy to insulin, primarily in adult patients with the phenotype of type 2 diabetes). In addition, epidemiological studies unequivocally documented that metformin is associated with lower cancer morbidity and mortality rates in type 2 diabetic patients. Metformin was used in diabetic patients with systolic heart failure and the results proved to be promising in a clinical trial. The use of metformin in type 2 diabetic patients with insulin treatment can result in a decrease in insulin dose, an improvement in glycaemic control, a beneficial effect in weight changes and a decrease in risk of macrovascular complications. A late and prolonged beneficial effect of a former favourable metabolic milieu could be expected even in the subsequent years after terminating a randomized controlled trial with metformin. Although the new clinical observations should be considered encouraging, our clinical practice should strictly follow the current guidelines based on the label of metformin.
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