Metformin is primarily suited for the treatment of subjects with non-insulin-dependent diabetes mellitus (type II diabetes). Compared to other antidiabetic agents, it has the advantages of lowering rather than increasing body weight, of not causing hypoglycemia, and of entailing a reduction of triglycerides and LDL-cholesterol levels. Metformin is therefore recommended in single drug therapy especially for obese subjects. In the majority of the treated subjects, a lowering of blood glucose levels by at least 25% is achieved (i.e. almost identical results as with sulfonylureas at the beginning of treatment).

Metformin can also be combined with other antidiabetic agents. It can thus e.g. be used when there is secondary failure with sulfonylureas. Occasionally a small dose of metformin combined with a sulfonylurea is sufficient to restore an adequate diabetic control. In carefully selected cases, a combination with insulin can also be sensible — particularly for obese subjects with relative insulin resistance.

Proof that the drug has an advantageous effect on the prognosis of diabetes (complications, mortality) does not exist.

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