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# Metformin
- URL: https://www.preanaesthesia.com/clinician-reference/metformin/
- Published: 2026-09-13T04:53:27.000Z
- Updated: 2026-09-13T19:07:30.000Z
- Description: Compare differing guideline recommendations and the patient-specific factors that inform a perioperative metformin plan.
- Author: preetam satish
- Tags: #clinician, #Import 2026-09-12 18:04

Perioperative metformin recommendations differ between guidelines.

## ADA 2026

The recommendation is to hold metformin and other oral glucose-lowering agents on the day of surgery/procedure.

## AHA/ACC 2024

The cardiovascular guidance states that continuation of metformin during the perioperative period is reasonable in patients with diabetes or impaired glucose tolerance.

## Applying the guidance

Local policy, renal function, contrast exposure, procedure characteristics and glycaemic plan therefore matter.

## Sources

- [ADA Standards of Care 2026, section 16](https://diabetesjournals.org/care/article/49/Supplement%5F1/S339/163925/16-Diabetes-Care-in-the-Hospital-Standards-of-Care)
- [2024 AHA/ACC perioperative cardiovascular guideline](https://professional.heart.org/en/science-news/2024-guideline-for-perioperative-cardiovascular-management-for-noncardiac-surgery)

## Related reading

- [Beta blockers](https://www.preanaesthesia.com/clinician-reference/beta-blockers/)
- [Statins](https://www.preanaesthesia.com/clinician-reference/statins/)
- [ACE inhibitors / ARBs / RAAS inhibitors](https://www.preanaesthesia.com/clinician-reference/ace-inhibitors-arbs-raas-inhibitors/)
- [SGLT2 inhibitors](https://www.preanaesthesia.com/clinician-reference/sglt2-inhibitors/)
- [Other oral glucose-lowering medicines](https://www.preanaesthesia.com/clinician-reference/other-oral-glucose-lowering-medicines/)