Another recommendation from the GVG from 2019 was to use metformin as the primary glucose lowering agent.1 As newer anti-diabetic drugs such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists lower the incidence of major adverse cardiovascular events in diabetes,24,25 they are now recommended instead of metformin as first-line therapy for type 2 DM in patients with atherosclerotic disease24,25 which might explain the relatively low number of patients on metformin. This evidence concerns the gene SLC5A2 and diabetes mellitus.