Metformin, diabetes treatment

Hanefeld M, Bar K. Efficacy and safety of combined treatment of type 2 diabetes with acarbose and metformin. Diabetes Stoffwechsel 1998 7 186-90. 

Vigneri R, Goldfine ID. Role of metformin in treatment of diabetes mellitus. Diabetes Care 1987 10(l) 118-22. 

It is well known that diabetic patients undergoing coronary interventions have worse chnical and angiographic outcomes in comparison with nondiabetic patients. In the retrospective analysis of the PRESTO (Prevention of Restenosis with Tranilast and its Outcomes) trial the effect of different anti-diabetic treatment was analysed [40] in 1,110 diabetic patients who received non-sensitizer therapy (insulin and/or sulfonylureas) and in 887 patients who were treated with sensitizers (metformin with or without additional therapy). Compared with patients on non-sensitizer therapy, those on sensitizer therapy showed an adjusted OR of 0.72 p = 0.005 for any clinical event. The differences between the non-sensitizer therapy group and the sensitizer group were attributable mainly to decreased rates of death (OR = 0.39 p = 0.007) and myocardial infarction (OR = 0.31 p = 0.002). In this retrospective analysis, use of metformin in diabetics undergoing coronary interventions appeared to decrease adverse clinical events, especially death and myocardial infarction, compared with diabetic patients treated with non-sensitizer therapy. 

Keywords Type 2 diabetes, treatment, insulin. Metformin, sulfonylurea, glitazones, triple therapy, glycaemic control. 

Bergenstal RM, Wysham C, MacConell L, Malloy J, Walsh B, Yan P, Wilhelm K, Malone J, Porter LE DURATION-2 Study Group. Efficacy and safety of exenatide once weekly versus sitagliptin or pioglita-zone as an adjunct to metformin for treatment of type 2 diabetes (DURATION-2) a randomised trial. Lancet 2010 376 431-9. 

A class of drug derived from guanidine, including metformin and phenformin. Metformin is currently widely used in humans for the treatment of type 2 diabetes. Phenformin was formerly also widely used but was withdrawn because of problems with lactic acidosis. 

Insulin is the drug treatment of choice for patients with either type 1 or type 2 diabetes during pregnancy glyburide can be used for type 2 diabetes after the eleventh week of gestation. Metformin is also an option. 

Type 2 diabetes mellitus For type 2 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy, with or without a concurrent sulfonylurea agent and/or metformin. 

Lactic acidosis Lactic acidosis is a rare, but serious, metabolic complication that can occur because of metformin accumulation during treatment when it occurs, it is fatal in approximately 50% of cases. Lactic acidosis also may occur in association with a number of pathophysiologic conditions, including diabetes mellitus, and whenever... 

Renal disease or renal dysfunction (eg, as suggested by serum creatinine levels greater than or equal to 1.5 mg/dL [males], greater than or equal to 1.4 mg/dL [females], or abnormal Ccr) that may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction (Ml), and septicemia CHF requiring pharmacologic treatment hypersensitivity to metformin acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Treat diabetic ketoacidosis with insulin. 

Chiidren Safety and efficacy of metformin IR for the treatment of type 2 diabetes have been established in children 10 to 16 years of age who demonstrated a similar response in glycemic control to that seen in adults. Adverse effects were similar to those described in adults. A maximum daily dose of 2,000 mg is recommended. Safety and efficacy of metformin ER in children have not been established. 

The drug metformin is useful in the treatment of patients with type 2 diabetes mellitus who are obese and whose hyperglycemia cannot be controlled by other agents. There are reports that some patients are predisposed to the toxic side effects of this drug, which include potentially fatal lactic acidosis. 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

Metformin works best in patients with significant hyperglycemia and is often considered first-line therapy in the treatment of mild to moderate type II overweight diabetics who demonstrate insulin resistance. The United Kingdom Prospective Diabetes Study demonstrated a marked reduction in cardiovascular comorbidities and diabetic complications in metformin-treated individuals. Metformin has also been used to treat hirsutism in individuals with polycystic ovarian syndrome and may enhance fertility in these women, perhaps by decreasing androgen levels and enhancing insulin sensitivity. 

Tight control of diabetes, with reduction of HbAic from 9.1% to 7%, was shown to reduce the risk of microvascular complications overall compared with that achieved with conventional therapy (mostly diet alone, which decreased HbAic to 7.9%). Cardiovascular complications were not noted for any particular therapy metformin treatment alone reduced the risk of macrovascular disease (myocardial infarction, stroke). Epidemiologic analysis of the study suggested that every 1% decrease in the Aic achieved an estimated risk reduction of 37% for microvascular complications, 21% for any diabetes-related endpoint and death related to diabetes, and 14% for myocardial infarction. 

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