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Effectiveness Of Metformin In Type 2 Diabetes

Metformin Remains Best First-line Therapy For Type 2 Diabetes

Metformin Remains Best First-line Therapy For Type 2 Diabetes

Metformin Remains Best First-line Therapy for Type 2 Diabetes Metformin should remain the first choice for the treatment of type 2 diabetes, even in the face of competition from a host of newer agents, concludes a new review. Nisa M Maruthur, MD, of Johns Hopkins University School of Medicine, Baltimore, Maryland, led the review, published today in the Annals of Internal Medicine. "We conclude that metformin should remain a first-line therapy because its effect on HbA1c is similar to other medications. Metformin has a long-term safety profile, it's weight neutral or helps people lose weight, it has gastrointestinal side effects but they are avoidable or tolerable, and of course metformin looks better for cardiovascular mortality than sulfonylureas," she told Medscape Medical News in an interview. Among the drugs evaluated along with metformin were the latest approvals for type 2 diabetes, including the newest class of sodiumglucose cotransporter 2 (SGLT2) inhibitors, the dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagonlike peptide-1 (GLP-1) receptor agonists. Other drugs reviewed were thiazolidinediones, sulfonylureas, and selected metformin-based combinations. Asked to comment, Darren McGuire, MD, of the University of Texas Southwestern Medical Center, Dallas, remarked: "I do find it odd that the justification for metformin first hinges on its comparison with sulfonylureas, which have minimal data available suggesting efficacy and ongoing concern about adverse cardiovascular effects. "That is, it is possible that sulfonylureas have adverse outcomes, which of course in these analyses will exaggerate what, if any, cardiovascular risk efficacy metformin has." Review Includes Latest Data on Newer Agents Amid the plethora of newly approved antidiabetic drugs and an Continue reading >>

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

INTRODUCTION Two classes of oral hypoglycemic drugs directly improve insulin action: biguanides (only metformin is currently available) and thiazolidinediones (TZDs). In the absence of contraindications, metformin is considered the first choice for oral treatment of type 2 diabetes (table 1). A 2006 consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), updated regularly, proposed that metformin therapy (in the absence of contraindications) be initiated, concurrent with lifestyle intervention, at the time of diabetes diagnosis [1-3]. The pharmacology, efficacy, and side effects of metformin for the treatment of diabetes will be reviewed here. A general discussion of initial treatment of type 2 diabetes and the role of metformin in the prevention of diabetes, in the treatment of polycystic ovary syndrome, and in gestational diabetes are reviewed separately. Continue reading >>

Scant Evidence On The Effectiveness Of Metformin In Type 2 Diabetes

Scant Evidence On The Effectiveness Of Metformin In Type 2 Diabetes

Scant evidence on the effectiveness of metformin in type 2 diabetes Scant evidence on the effectiveness of metformin in type 2 diabetes BMJ 2015; 350 doi: (Published 19 May 2015) Cite this as: BMJ 2015;350:h2650 Thomas L Perry, general internist and university professor 1 1Department of Anaesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada V6T 2B5 Metformin is remarkably safe compared with alternative drugs for type 2 diabetes, although it does cause at least chemical vitamin B12 deficiency. 1 2 The problem of reduced glomerular filtration can be seen as an advantage for drugs like metformin that are eliminated through the kidney. Reduced clearance and longer elimination half life imply lower or less frequent doses, with small but useful cost savings. Benefits of metformin may not be dose dependent, so a low dose (such as 500 mg/day) may not only be safe but potentially optimal for people with a low glomerular filtration rate. It has been pointed out that randomised controlled trials of metformin in renal failure might not be popular, although they could be conducted safely, practically, and therefore ethically. 3 The evidence for metformins effectiveness in type 2 diabetes derives almost entirely from 342 patients with a mean body mass index of 31.6, who were treated with a high carbohydrate diet. 4 The number of clinical events on which we base our current judgments of effectiveness is startlingly small. We have remarkably little (if any) reliable information on how best to treat type 2 diabetes. Thus, it would be helpful for opinion leaders to organise more trials comparing metformin with other treatments, including in people with physiologically significant kidney disease. Wouldnt it be more ethical to conduct such tr Continue reading >>

Efficacy Of Metformin In Type Ii Diabetes: Results Of A Double-blind,placebo-controlled, Dose-response Trial.

Efficacy Of Metformin In Type Ii Diabetes: Results Of A Double-blind,placebo-controlled, Dose-response Trial.

Efficacy of metformin in type II diabetes: results of a double-blind,placebo-controlled, dose-response trial. Garber AJ(1), Duncan TG, Goodman AM, Mills DJ, Rohlf JL. (1)Department of Medicine, Baylor College of Medicine, Houston, Texas, USA. PURPOSE: To study the efficacy and safety of various dosages of metformin ascompared with placebo in patients with type II diabetes mellitus.PATIENTS AND METHODS: A 14-week, multicenter, double-blind, dose-response studywas conducted. After a 3-week, single-blind, placebo-controlled washout, 451patients with fasting plasma glucose levels of at least 180 mg/dL were randomizedto receive an 11-week course of placebo or metformin given at 500, 1000, 1500,2000, or 2500 mg daily.RESULTS: Metformin improved glucose variables as compared with placebo. Theadjusted mean changes in fasting plasma glucose from baseline associated witheach metformin group at week 7, 11, or at endpoint exceeded those associated withplacebo by 19 to 84 mg/dL at dosages of 500 to 2000 mg daily, respectively. Thecorresponding between-group differences in glycated hemoglobin (HbA1c) rangedfrom 0.6% to 2.0% at dosages of 500 to 2000 mg daily, respectively. Allbetween-group differences were significant (P < 0.05) for both fasting plasmaglucose and HbA1c at week 7, week 11, and endpoint, except for the differencebetween placebo and metformin 500 mg in fasting plasma glucose at endpoint (P =0.054). Treatment-related adverse events occurred in 15% of patients in theplacebo group and in 28% in the metformin group (P = 0.02); these were primarily manifested as digestive disturbances, such as diarrhea.CONCLUSIONS: Metformin lowered fasting plasma glucose and HbA1c generally in adose-related manner. Benefits were observed with as little as 500 mg ofmetformin; maximal benefi Continue reading >>

Efficacy Of Metformin In Type Ii Diabetes: Results Of A Double-blind, Placebo-controlled, Dose-response Trial - Sciencedirect

Efficacy Of Metformin In Type Ii Diabetes: Results Of A Double-blind, Placebo-controlled, Dose-response Trial - Sciencedirect

Get rights and content PURPOSE: To study the efficacy and safety of various dosages of metformin as compared with placebo in patients with type II diabetes mellitus. PATIENTS AND METHODS: A 14-week, multicenter, double-blind, dose-response study was conducted. After a 3-week, single-blind, placebo-controlled washout, 451 patients with fasting plasma glucose levels of at least 180 mg/dL were randomized to receive an 11-week course of placebo or metformin given at 500, 1000, 1500, 2000, or 2500 mg daily. RESULTS: Metformin improved glucose variables as compared with placebo. The adjusted mean changes in fasting plasma glucose from baseline associated with each metformin group at week 7, 11, or at endpoint exceeded those associated with placebo by 19 to 84 mg/dL at dosages of 500 to 2000 mg daily, respectively. The corresponding between-group differences in glycated hemoglobin (HbA1c) ranged from 0.6% to 2.0% at dosages of 500 to 2000 mg daily, respectively. All between-group differences were significant (P < 0.05) for both fasting plasma glucose and HbA1c at week 7, week 11, and endpoint, except for the difference between placebo and metformin 500 mg in fasting plasma glucose at endpoint (P = 0.054). Treatment-related adverse events occurred in 15% of patients in the placebo group and in 28% in the metformin group (P = 0.02); these were primarily manifested as digestive disturbances, such as diarrhea. CONCLUSIONS: Metformin lowered fasting plasma glucose and HbA1c generally in a dose-related manner. Benefits were observed with as little as 500 mg of metformin; maximal benefits were observed at the upper limits of the recommended daily dosage. All dosages were well tolerated. Metformin appears to be a useful therapeutic option for physicians who wish to titrate drug thera Continue reading >>

Efficacy And Tolerance Of Cost Effective Teneligliptin With Metformin In Type 2 Diabetes Mellitus- A Short Study | 61316

Efficacy And Tolerance Of Cost Effective Teneligliptin With Metformin In Type 2 Diabetes Mellitus- A Short Study | 61316

Teneligliptin is a novel, highly selective dipeptidyl peptidase-4 (DPP-4) inhibitor. The aim of the study was to assess theeffectiveness of Metformin in combination with teneligliptin in Indian patients with type 2 diabetes mellitus who wereinadequately controlled with metformin monotherapy. Patients with Glycated haemoglobin (HbA1c) of 7.010.0% and onmetformin 1000 mg/day were selected for the study. 400 subjects were enrolled out of which only 120 subjects were eligiblefor the study. The study group of 120 subjects were divided into two groups, Group A (n=60) was given 20 mg teneligliptin plusmetformin, Group B were on metformin (n=60). The mean baseline HbA1c in teneligliptin group was 8.0%, when comparedto 7.8% in the Metformin group. The primary endpoint of the study was to monitor the changes in HbA1c levels from baselineto week 24. It was observed that the mean HbA1c for teneligliptin group after 24 weeks was 7.17 % versus 7.62 % in metformingroup. HbA1c was significantly reduced in the Group A patients. The incidence of gastro-intestinal adverse events was more inmetformin group than teneligliptin groups. In patients treated on metformin an additional dosage of teneligliptin once dailywas effective and it was well tolerated in Indian patients with type 2 diabetes mellitus. There was neither any significant changeobserved with respect to lipid profile and body weight. Riyaz Mohammed has completed his Post-graduation in Internal Medicine from Prestigious Deccan College of Medical Sciences and then he did his Masters in Endocrinology from Texila American University and Diploma in Endocrinology from University of South Wales, UK. He is the Director of Esani Diabetes and Multispecialty Research Centre in India. At a young age, he was heading the Department of Medici Continue reading >>

Effects Of Sulfonylureas And Metformin On Cardiovascular Events | Annals Of Internal Medicine | American College Of Physicians

Effects Of Sulfonylureas And Metformin On Cardiovascular Events | Annals Of Internal Medicine | American College Of Physicians

Article, Author, and Disclosure Information Author, Article, and Disclosure Information From Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, Health Services Research and Development Center, and Vanderbilt University, Nashville, Tennessee. Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the Department of Veterans Affairs. Grant Support: This project was funded under contract 290-05-0042 from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, as part of the Developing Evidence to Inform Decisions about Effectiveness program. Drs. Roumie (04-342-2) and Hung (2-031-09S) were supported by Veterans Affairs Career Development Awards. Dr. Roumie was also supported in part by the Vanderbilt Clinical Translational Scientist Award UL1 RR024975-01 from the National Center for Research Resources/National Institutes of Health. Support for Veterans Affairs/Centers for Medicare & Medicaid Services data provided by the Department of Veterans Affairs, Veterans Affairs Health Services Research and Development Service, Veterans Affairs Information Resource Center (project numbers SDR 02-237 and 98-004). Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0009 . Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Roumie (e-mail, [email protected] ). Data set: Not available. Requests for Single Reprints: Christianne L. Roumie, MD, MPH, Nashville Veterans Affairs Medic Continue reading >>

Efficacy And Renal Safety Of Dapagliflozin In Patients With Type 2 Diabetes Mellitus Also Receiving Metformin: A Real-life Experience

Efficacy And Renal Safety Of Dapagliflozin In Patients With Type 2 Diabetes Mellitus Also Receiving Metformin: A Real-life Experience

Efficacy and Renal Safety of Dapagliflozin in Patients with Type 2 Diabetes Mellitus Also Receiving Metformin: A Real-Life Experience 1Regional Referral Centre for Insulin Pump Implantation and Diabetes, Civic Hospital, Partinico, Palermo, Italy 2Department of Internal Medicine, University of Palermo, Palermo, Italy Correspondence should be addressed to Alessandro Scorsone ; [email protected] Received 21 September 2017; Revised 5 March 2018; Accepted 13 March 2018; Published 3 May 2018 Copyright 2018 Alessandro Scorsone et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. This study aimed at evaluating the efficacy and safety of dapagliflozin in patients with type 2 diabetes (T2D) who also received metformin in clinical practice in Italy. Methods. This was a retrospective observational study and it included data from patients who received dapagliflozin 10 mg once daily in conjunction with metformin for 12 months (DAPA + MET). In those with inadequate glycemic control, insulin or glimepiride was added after 30 days (DAPA + MET + other glucose-lowering drugs). Efficacy assessments included glycosylated hemoglobin (HbA1c) levels at 6 and 12 months, as well as body mass index (BMI) and lipid parameters at 12 months. Safety was also assessed. Results. Data on 66 patients were included. In both groups, HbA1c was significantly reduced at 6 and 12 months compared with baseline and significant reductions in HbA1c were observed at 12 months compared with 6 months. Over the 12-month treatment period, dapagliflozin significantly reduced BMI in both groups. No significant changes in lipid paramet Continue reading >>

Efficacy Of Metformin In Patients With Non-insulin-dependent Diabetes Mellitus

Efficacy Of Metformin In Patients With Non-insulin-dependent Diabetes Mellitus

Sulfonylurea drugs have been the only oral therapy available for patients with non-insulin-dependent diabetes mellitus (NIDDM) in the United States. Recently, however, metformin has been approved for the treatment of NIDDM. We performed two large, randomized, parallel-group, double-blind, controlled studies in which metformin or another treatment was given for 29 weeks to moderately obese patients with NIDDM whose diabetes was inadequately controlled by diet (protocol 1: metformin vs. placebo; 289 patients), or diet plus glyburide (protocol 2: metformin and glyburide vs. metformin vs. glyburide; 632 patients). To determine efficacy we measured plasma glucose (while the patients were fasting and after the oral administration of glucose), lactate, lipids, insulin, and glycosylated hemoglobin before, during, and at the end of the study. In protocol 1, at the end of the study the 143 patients in the metformin group, as compared with the 146 patients in the placebo group, had lower mean (±SE) fasting plasma glucose concentrations (189±5 vs. 244±6 mg per deciliter [10.6±0.3 vs. 13.7±0.3 mmol per liter], P<0.001) and glycosylated hemoglobin values (7.1±0.1 percent vs. 8.6±0.2 percent, P<0.001). In protocol 2, the 213 patients given metformin and glyburide, as compared with the 209 patients treated with glyburide alone, had lower mean fasting plasma glucose concentrations (187±4 vs. 261±4 mg per deciliter [10.5±0.2 vs. 14.6±0.2 mmol per liter], P<0.001) and glycosylated hemoglobin values (7.1±0.1 percent vs. 8.7±0.1 percent, P<0.001). The effect of metformin alone was similar to that of glyburide alone. Eighteen percent of the patients given metformin and glyburide had symptoms compatible with hypoglycemia, as compared with 3 percent in the glyburide group and 2 pe Continue reading >>

Effectiveness And Safety Of Metformin In 51 675 Patients With Type 2 Diabetes And Different Levels Of Renal Function: A Cohort Study From The Swedish National Diabetes Register

Effectiveness And Safety Of Metformin In 51 675 Patients With Type 2 Diabetes And Different Levels Of Renal Function: A Cohort Study From The Swedish National Diabetes Register

Objective To evaluate the effectiveness and safety of metformin use in clinical practice in a large sample of pharmacologically treated patients with type 2 diabetes and different levels of renal function. Participants 51 675 men and women with type 2 diabetes, registered in the Swedish National Diabetes Register, and on continuous glucose-lowering treatment with oral hypoglycaemic agents (OHAs) or insulin. Main outcome measures Risks of cardiovascular disease (CVD), all-cause mortality and acidosis/serious infection, associated with each treatment regimens, were analysed in all patients and in subgroups with different estimated glomerular filtration rate (eGFR) intervals. Covariance adjustment and propensity scores were used to adjust for several baseline risk factors and characteristics at Cox regression. Results Compared with metformin in monotherapy, HRs for fatal/non-fatal CVD and all-cause mortality with all other OHAs combined (approximately 80% sulphonylureas) in monotherapy were 1.02 (95% CI 0.93 to 1.12) and 1.13 (1.01 to 1.27), while 1.18 (1.07 to 1.29) and 1.34 (1.19 to 1.50) with insulin in monotherapy, adjusting using propensity scores. Metformin, compared with any other treatment, showed reduced risks of acidosis/serious infection (adjusted HR 0.85, 95% CI 0.74 to 0.97) and all-cause mortality (HR 0.87, 95% CI 0.77 to 0.99), in patients with eGFR 45–60 ml/min/1.73 m2, and no increased risks of all-cause mortality, acidosis/serious infection or CVD were found in patients with eGFR 30–45 ml/min/1.73 m2. Conclusions Metformin showed lower risk than insulin for CVD and all-cause mortality and slightly lower risk for all-cause mortality compared with other OHA, in these 51 675 patients followed for 4 years. Patients with renal impairment showed no increase Continue reading >>

The Cost-effectiveness Of Lifestyle Modification Or Metformin In Preventing Type 2 Diabetes In Adults With Impaired Glucose Tolerance

The Cost-effectiveness Of Lifestyle Modification Or Metformin In Preventing Type 2 Diabetes In Adults With Impaired Glucose Tolerance

The Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired Glucose Tolerance William H. Herman, MD, MPH; Thomas J. Hoerger, PhD; Michael Brandle, MD, MS; Katherine Hicks, MS; Stephen Sorensen, PhD; Ping Zhang, PhD; Richard F. Hamman, MD, DrPH; Ronald T. Ackermann, MD, MPH; Michael M. Engelgau, MD, MS; Robert E. Ratner, MD; for the Diabetes Prevention Program Research Group* From University of Michigan Health System, Ann Arbor, Michigan; RTI International, Research Triangle Park, North Carolina; Centers for Disease Control and Prevention, Atlanta, Georgia; University of Colorado Health Sciences Center, Denver, Colorado; Indiana University School of Medicine, Indianapolis, Indiana; and Medstar Research Institute, Hyattsville, Maryland. From University of Michigan Health System, Ann Arbor, Michigan; RTI International, Research Triangle Park, North Carolina; Centers for Disease Control and Prevention, Atlanta, Georgia; University of Colorado Health Sciences Center, Denver, Colorado; Indiana University School of Medicine, Indianapolis, Indiana; and Medstar Research Institute, Hyattsville, Maryland. From University of Michigan Health System, Ann Arbor, Michigan; RTI International, Research Triangle Park, North Carolina; Centers for Disease Control and Prevention, Atlanta, Georgia; University of Colorado Health Sciences Center, Denver, Colorado; Indiana University School of Medicine, Indianapolis, Indiana; and Medstar Research Institute, Hyattsville, Maryland. From University of Michigan Health System, Ann Arbor, Michigan; RTI International, Research Triangle Park, North Carolina; Centers for Disease Control and Prevention, Atlanta, Georgia; University of Colorado Health Sciences Center, Denver, Colorado; Indiana Univer Continue reading >>

Effectiveness Of Invokamet In Drug-nave Type 2 Diabetes

Effectiveness Of Invokamet In Drug-nave Type 2 Diabetes

Home / Conditions / Type 2 Diabetes / Effectiveness of Invokamet in Drug-Nave Type 2 Diabetes Effectiveness of Invokamet in Drug-Nave Type 2 Diabetes Study answers question of just how effective is a SGLT-2 inhibitor with metformin. Metformin (MET) is the first choice to improve glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose by decreasing hepatic glucose production and intestinal absorption. Also, it increases peripheral glucose uptake and utilization, thus improving insulin sensitivity. On the other hand, Canagliflozin (CANA) is a Sodium-Glucose Cotransporter 2 (SGLT2) inhibitor that lowers the renal threshold for glucose and increases urinary glucose excretion by interfering with the reabsorption of renally filtered glucose across the tubular lumen of the proximal renal tubules. The objective of this study is to compare the effectiveness of the combination therapy of CANA and MET extended release (XR) versus CANA alone or MET XR alone in patients with drug nave type 2 diabetes with inadequate control despite lifestyle management with diet and exercise. The study also assessed the safety and tolerability of CANA. The study was a double-blinded, parallel group, phase 3 study over 26 weeks. A total of 1,186 participants were randomized into five-arms of 216 participants in each to receive CANA100/MET XR, CANA300/MET XR, CANA100, CANA300, or MET XR. In the first 2 arms, participants received either CANA100 or CANA300 capsule before the morning meal, a placebo with the evening meal, and a placebo with the evening meal to match the MET XR. In the 3rd arm, participants received MET XR once daily in titrated doses over nine weeks, a placebo before the morning meal and a placebo with the evening meal to match the CANA. Continue reading >>

A New Dual Drug Pill Aims To Boost The Effectiveness Of Metformin

A New Dual Drug Pill Aims To Boost The Effectiveness Of Metformin

Joslin does not endorse specific products or companies. This post is meant to be informational only. This October the FDA approved a new two-in-one pill to treat type 2 diabetes. The drug, marketed as Xigduo© by the British pharmaceutical company AstraZeneca, contains both metformin and a newer compound called dapagliflozin. When prescribed alongside healthy diet and exercise, this new dual-drug lowers blood glucose levels and helps patients lose weight. “Metformin, which has been available in the US for the past twenty years, works by inhibiting glucose production in the liver and improving the ability of the body to react to insulin,” says Robert Gabbay, MD, PhD, the Chief Medical Officer and Senior Vice President of the Joslin Diabetes Center. Since Metformin is the first line of drug of choice for the treatment of type 2 diabetes as well as pre-diabetes, many patients are prescribed metformin. But sometimes high doses of metformin can cause gastrointestinal distress including diarrhea, cramps, nausea, vomiting, and increased flatulence. If these side effects are particularly troubling or if patients are resistant to the drug the highest dose of metformin isn’t lowering blood glucose levels enough, that’s where the dapagliflozin steps in. Metformin and dapagliflozin are complementary. Dapagliflozin does the same job of lowing blood glucose levels but it works elsewhere in the body so it doesn’t interfere with the metformin. When prescribed together, patients can lower their blood glucose levels more successfully. Dapagliflozin works by blocking a protein in the kidneys called sodium-glucose co-transporter 2 (SGLT2). Normally, SGLT2 absorbs glucose from the urine and pushes it into the bloodstream as blood filters through the kidneys. But the dapagliflozin Continue reading >>

Cost-effectiveness Analysis Of Intensive Blood-glucose Control With Metformin In Overweight Patients With Type Ii Diabetes (ukpds No. 51)

Cost-effectiveness Analysis Of Intensive Blood-glucose Control With Metformin In Overweight Patients With Type Ii Diabetes (ukpds No. 51)

Aims/hypothesis. To estimate the economic efficiency of intensive blood-glucose control with metformin compared with conventional therapy primarily with diet in overweight patients with Type II (non-insulin-dependent) diabetes mellitus. Methods. Cost-effectiveness analysis based on patient level data from a randomised clinical controlled trial involving 753 overweight ( > 120 % ideal body weight) patients with newly diagnosed Type II diabetes conducted in 15 hospital-based clinics in England, Scotland and Northern Ireland as part of the UK Prospective Diabetes Study. Subjects were allocated at random to an intensive blood-glucose control policy with metformin (n = 342) or a conventional policy primarily with diet (n = 411). The analysis was based on the cost of health care resources associated with metformin and conventional therapy and the estimated effectiveness in terms of life expectancy gained from within-trial effects. Results. Intensive blood-glucose control with metformin produced a net saving of 258 per patient (1997 United Kingdom prices) over the trial period (median duration of 10.7 years) due to lower complication costs, and increased life expectancy by 0.4 years (costs and benefits discounted at 6 %). Conclusions/interpretation. As metformin is both cost-saving in the United Kingdom and extends life expectancy when used as first line pharmacological therapy in overweight Type II diabetic patients, its use should be attractive to clinicians and health care managers alike. [Diabetologia (2001) 44: 298304] Keywords Economic evaluationcost-effectiveness analysisType II diabetesmetforminoverweight patientcost saving. Received: 5 September 2000 and in revised form: 2 November 2000 Continue reading >>

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Abstract The management of T2DM requires aggressive treatment to achieve glycemic and cardiovascular risk factor goals. In this setting, metformin, an old and widely accepted first line agent, stands out not only for its antihyperglycemic properties but also for its effects beyond glycemic control such as improvements in endothelial dysfunction, hemostasis and oxidative stress, insulin resistance, lipid profiles, and fat redistribution. These properties may have contributed to the decrease of adverse cardiovascular outcomes otherwise not attributable to metformin’s mere antihyperglycemic effects. Several other classes of oral antidiabetic agents have been recently launched, introducing the need to evaluate the role of metformin as initial therapy and in combination with these newer drugs. There is increasing evidence from in vivo and in vitro studies supporting its anti-proliferative role in cancer and possibly a neuroprotective effect. Metformin’s negligible risk of hypoglycemia in monotherapy and few drug interactions of clinical relevance give this drug a high safety profile. The tolerability of metformin may be improved by using an appropiate dose titration, starting with low doses, so that side-effects can be minimized or by switching to an extended release form. We reviewed the role of metformin in the treatment of patients with type 2 diabetes and describe the additional benefits beyond its glycemic effect. We also discuss its potential role for a variety of insulin resistant and pre-diabetic states, obesity, metabolic abnormalities associated with HIV disease, gestational diabetes, cancer, and neuroprotection. Introduction The discovery of metformin began with the synthesis of galegine-like compounds derived from Gallega officinalis, a plant traditionally em Continue reading >>

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