Expert panel discussion

Prescribing antidiabetic drugs for patients with renal dysfunction John Wilding BM, DM, FRCP, Mike Kirby FRCP and Marc Evans MD, FRCP In this Expert Panel Discussion the participants discuss the options available for treating diabetes patients who have some degree of renal impairment.

John Wilding, professor of medicine and honorary consultant physician, head of Department of Obesity and Endocrinology, Clinical Sciences Centre, University Hospital Aintree, Liverpool Mike Kirby, visiting professor, Faculty of Health and Human Sciences, Centre for Research in Primary & Community Care  (CRIPACC), University of Hertfordshire Marc Evans, consultant diabetologist, Llandough Hospital, Wales JOHN WILDING: We are going to discuss prescrib-

ing in patients with diabetes and renal impairment, focusing on the range of glucose-lowering drugs. The first-line treatment for patients with diabetes (after diet and exercise) is metformin. There has been a lot of confusion recently about the use of metformin in patients with renal impairment. MIKE KIRBY: There is confusion because the

Summary of Product Characteristics (SPC) for metformin1 advises that the drug should not be used when the creatinine clearance is below 60ml per minute. Most clinicians use metformin until the estimated glomerular filtration rate (eGFR) falls to