Metformin : from public health issue to perioperative strategy

Metformin is the reference oral antidiabetic for the treatment of type 2 diabetes. Despite its many advantages (low cost, easy dosage and administration, few side effects, etc.), its use is the subject of debate, particularly in the perioperative context, due to the risk of lactic acidosis. The growing incidence of type 2 diabetes means that anaesthetists regularly manage patients on metformin. This review describes the public health issues associated with type 2 diabetes and metformin and summarizes the pharmacological properties of metformin. Next, metformin-related metabolic acidosis is detailed. Finally, we describe what anaesthetists need to know when managing patients treated with metformin.