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[Correspondence] Metformin as first-line treatment for type 2 diabetes

We read with interest the letter by Remy Boussageon and colleagues1 (March 31, p 1261) discussing the certainty of evidence for metformin as first-line treatment for type 2 diabetes, in response to a Seminar by Sudesna Chatterjee and colleagues.2 As stated in the Seminar,2 metformin monotherapy is recommended by the American Diabetes Association clinical practice guidelines3 as the initial glucose-lowering therapy for type 2 diabetes, with addition of second-line treatments on the basis of considerations of efficacy, risk of hypoglycaemia, weight, side-effects, and costs.