<p><strong>Elderly</strong>: Due to the potential for decreased renal function in elderly subjects, the metformin dosage should be adjusted based on renal function. Regular assessment of renal function is necessary.<br />
<br />
<strong>Pediatric population</strong>: The diagnosis of type 2 diabetes mellitus should be confirmed before treatment with metformin is initiated. No effect of metformin on growth and puberty has been detected during controlled clinical studies of one-year duration but no long-term data on these specific points are available. Therefore, a careful follow-up of the effect of metformin on these parameters in metformin-treated children, especially prepubescent children, is recommended.<br />
<br />
<strong>Children aged between 10 and 12 years</strong>: Particular caution is recommended when prescribing to children aged between 10 and 12 years.<br />
<br />
<strong>Renal function</strong>: As metformin is excreted by the kidney, creatinine clearance (this can be estimated from serum creatinine levels by using the Cockcroft-Gault formula) should be determined before initiating treatment and regularly thereafter:</p>

<ul>
	<li>At least annually in patients with normal renal function,</li>
	<li>At least two to four times a year in patients with creatinine clearance at the lower limit of normal and in elderly subjects.</li>
</ul>

<p>Decreased renal function in elderly subjects is frequent and asymptomatic. Special caution should be exercised in situations where renal function may become impaired, for example when initiating antihypertensive therapy or diuretic therapy and when starting therapy with a non-steroidal anti-inflammatory drug (NSAID). GFR should be assessed before treatment initiation and regularly thereafter. Metformin is contraindicate in patients with GFR&lt;30 ml/min and should be temporarily discontinued in the presence of conditions that alter renal function.</p>