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Metformin Dosage

Glucophage

Glucophage

GLUCOPHAGE® (metformin hydrochloride) Tablets GLUCOPHAGE® XR (metformin hydrochloride) Extended-Release Tablets DESCRIPTION GLUCOPHAGE® (metformin hydrochloride) Tablets and GLUCOPHAGE® XR (metformin hydrochloride) Extended-Release Tablets are oral antihyperglycemic drugs used in the management of type 2 diabetes. Metformin hydrochloride (N,N-dimethylimidodicarbonimidic diamide hydrochloride) is not chemically or pharmacologically related to any other classes of oral antihyperglycemic agents. The structural formula is as shown: Metformin hydrochloride is a white to off-white crystalline compound with a molecular formula of C4H11N5 HCl and a molecular weight of 165.63. Metformin hydrochloride is freely soluble in water and is practically insoluble in acetone, ether, and chloroform. The pK of metformin is 12.4. The pH of a 1% aqueous solution of metformin hydrochloride is 6.68. GLUCOPHAGE tablets contain 500 mg, 850 mg, or 1000 mg of metformin hydrochloride. Each tablet contains the inactive ingredients povidone and magnesium stearate. In addition, the coating for the 500 mg and 850 mg tablets contains hypromellose and the coating for the 1000 mg tablet contains hypromellose and polyethylene glycol. GLUCOPHAGE XR contains 500 mg or 750 mg of metformin hydrochloride as the active ingredient. GLUCOPHAGE XR 500 mg tablets contain the inactive ingredients sodium carboxymethyl cellulose, hypromellose, microcrystalline cellulose, and magnesium stearate. GLUCOPHAGE XR 750 mg tablets contain the inactive ingredients sodium carboxymethyl cellulose, hypromellose, and magnesium stearate. System Components And Performance GLUCOPHAGE XR comprises a dual hydrophilic polymer matrix system. Metformin hydrochloride is combined with a drug release controlling polymer to form an “inne Continue reading >>

Kazano (alogliptin And Metformin Hcl Tablets): Side Effects, Interactions, Warning, Dosage & Uses

Kazano (alogliptin And Metformin Hcl Tablets): Side Effects, Interactions, Warning, Dosage & Uses

Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metforminassociated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (greater than 5 mmol/L), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio; and metformin plasma levels generallygreater than 5 mcg/mL [see WARNINGS AND PRECAUTIONS ]. Risk factors for metformin-associated lactic acidosis include renal impairment,concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such astopiramate), age 65 years old or greater, having a radiological study with contrast,surgery and other procedures, hypoxic states (e.g., acute congestive heart failure),excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the Full Prescribing Information [see DOSAGE AND ADMINISTRATION , CONTRAINDICATIONS , WARNINGS AND PRECAUTIONS , DRUG INTERACTIONS , and Use In Specific Populations ]. If metformin-associated lactic acidosis is suspected, immediately discontinueKAZANO and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended [see WARNINGS AND PRECAUTIONS ]. KAZANO tablets contain two oral antihyperglycemic drugs used in the management of type 2 diabetes : alogliptin and metformin hydrochloride. Alogliptin is a selective, orally bioavailable inhibitor of the enzymatic activity of dipeptidyl peptidase -4 (DPP-4). Chemically, alogliptin is Continue reading >>

Effects Of Dosage And Dosing Frequency On The Efficacy And Safety Of High-dose Metformin In Japanese Patients With Type 2 Diabetes Mellitus.

Effects Of Dosage And Dosing Frequency On The Efficacy And Safety Of High-dose Metformin In Japanese Patients With Type 2 Diabetes Mellitus.

Abstract AIMS/INTRODUCTION: Differences in the efficacy and safety of antidiabetic drugs among different ethnic groups are well documented. Metformin is widely used in the treatment of type 2 diabetes in Western countries, but high doses of metformin have been approved only recently for clinical use in Japan. The aim of the present study was to investigate the effects of dosage and dosing frequency on the efficacy and safety of high-dose metformin in Japanese patients. MATERIALS AND METHODS: A total of 71 Japanese patients with type 2 diabetes were prospectively studied for the effects of dosage and dosing frequency on the efficacy and safety of metformin during hospitalization. Dose effects were studied in 27 patients treated with 0, 500, 1,000, 1,500 and 2,250 mg/day of metformin. The effect of dosing frequency was compared in 56 patients with 1,500 mg/day of metformin administered either two or three times per day. RESULTS: Significant dose-dependent improvement in daily profiles of blood glucose was observed with metformin dosages up to 1,500 mg/day, with a trend towards further improvement observed at 2,250 mg/day. The efficacy of 1,500 mg of metformin was comparable when the drug was administered either two or three times per day. The most frequently reported side-effects were gastrointestinal symptoms, which were not affected by the dosage or dosing frequency of metformin. CONCLUSIONS: These results show that the efficacy of high-dose metformin is dose-dependent in Japanese patients. The efficacy and safety of metformin were similar when the drug was administered either two or three times per day. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd. Continue reading >>

Glipizide-metformin Side Effects

Glipizide-metformin Side Effects

Glipizide and metformin is a combination of two oral diabetes medicines that help control blood sugar levels. Glipizide and metformin is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes. This medicine is not for treating type 1 diabetes. Glipizide and metformin may also be used for purposes not listed in this medication guide. You should not use glipizide and metformin if you have severe kidney disease, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking glipizide and metformin. Some people taking metformin develop a serious condition called lactic acidosis. Stop taking this medicine and get emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired. You should not use this medicine if you are allergic to glipizide or metformin, or if you have: severe kidney disease; or metabolic acidosis or diabetic ketoacidosis (call your doctor for treatment). If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking glipizide and metformin. To make sure glipizide and metformin is safe for you, tell your doctor if you have: kidney disease; congestive heart failure, especially if you take digoxin (Lanoxin) or furosemide (Lasix); a genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency; liver disease; heart disease; or if you are over 80 years old and have not Continue reading >>

Metformin Dosage

Metformin Dosage

Usual Adult Dose for Diabetes Type 2 Immediate-release: Initial dose: 500 mg orally twice a day or 850 mg orally once a day Dose titration: Increase in 500 mg weekly increments or 850 mg every 2 weeks as tolerated Maintenance dose: 2000 mg daily in divided doses Maximum dose: 2550 mg/day Extended-release: Initial dose: 500 to 1000 mg orally once a day Dose titration: Increase in 500 mg weekly increments as tolerated Maintenance dose: 2000 mg daily Maximum dose: 2500 mg daily Comments: -Metformin, if not contraindicated, is the preferred initial pharmacologic agent for treatment of type 2 diabetes mellitus. -Immediate-release: Take in divided doses 2 to 3 times a day with meals; titrate slowly to minimize gastrointestinal side effects. In general, significant responses are not observed with doses less than 1500 mg/day. -Extended-release: Take with the evening meal; if glycemic control is not achieved with 2000 mg once a day, may consider 1000 mg of extended-release product twice a day; if glycemic control is still not achieve, may switch to immediate-release product. Use: To improve glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise. Usual Pediatric Dose for Diabetes Type 2 10 years or older: Immediate-release: Initial dose: 500 mg orally twice a day Dose titration: Increase in 500 mg weekly increments as tolerated Maintenance dose: 2000 mg daily Maximum dose: 2000 mg daily Comments: Take in divided doses 2 to 3 times a day with meals. Titrate slowly to minimize gastrointestinal side effects. Safety and effectiveness of metformin extended-release has not been established in pediatric patients less than 18 years of age. Use: To improve glycemic control in children with type 2 diabetes mellitus as an adjunct to diet and exercise. Le Continue reading >>

Safe Prescribing Of Metformin In Diabetes

Safe Prescribing Of Metformin In Diabetes

Metformin is the first-line pharmacological therapy for type 2 diabetes. It is the only glucose-lowering oral drug that has been shown to reduce mortality in patients with diabetes. The most common adverse effect is gastrointestinal upset. Starting at a low dose and increasing it slowly reduces this risk. Taking metformin with food also helps. Numerous contraindications to the use of metformin are listed in the product information, including reduced renal function. Strict adherence to these recommendations may deny a valuable drug to many patients. Introduction Metformin lowers both fasting and postprandial blood glucose. It reduces hepatic glucose output 1 and increases peripheral glucose uptake, and may delay intestinal glucose absorption. Its use is not associated with weight gain and hypoglycaemia is extremely rare when metformin is used on its own. It lowers triglyceride concentrations and has small but beneficial effects on total and high-density lipoprotein cholesterol. In the UK Prospective Diabetes Study metformin reduced diabetes-related and all-cause mortality, and reduced the risk of myocardial infarction in obese patients with type 2 diabetes when used as first-line therapy. It also reduced the risk of microvascular complications, but was no more effective than insulin or sulfonylureas. 2 A retrospective cohort study from the USA found a lower rate of hospitalisations for myocardial infarction and stroke and a reduced death rate when metformin was used first-line in type 2 diabetes in comparison with a sulfonylurea. 3 Metformin is effective when used with other glucose-lowering drugs. A standard-release (3000 mg/day maximum dose) and an extended-release preparation of metformin (2000 mg/day maximum dose) are available. The extended-release preparation can b Continue reading >>

Update-increasing Metformin To Maximum Dosage

Update-increasing Metformin To Maximum Dosage

Update-increasing metformin to maximum dosage Update-increasing metformin to maximum dosage As I posted last week, at my last weeks dr's appt I asked if I could increase my metformin to 3 x 850 a day from 2 x 850. My doctor was very skeptical whether that would make a difference an wanted to add another drug. Well I was wary of that so I convinced him to increase the dose of met. At first I didn't notice any difference, in fact the first day numbers were higher. But after almost a week I have noticed about a 5-10 point drop in fasting and less of a DP impact between 5 am and 7 am. At 4 am today I was 102 and at 7 I was 111. Last week I was 105-110 at 4 am and 120-130 at 7 am. The big thing I noticed is that I'm not getting any DP spikes late in the morning if I don't eat enough. This morning I had an Extend Bar for breakfast at 8:30 and tested at 10:30 and was still 111. Last week that would have been 130-140. I also notice throughout the day my bg range has been very stable 100-120. Now, understand I stick to a pretty low carb diet and am trying to do better sticking to it (Davids August Challenge) Although I usually exercise every day or every other day, this last week I have slacked off because of the heat and a few sore parts of my body. So I would say lower numbers are probalby due to higher met dose and tighter carb control. I really haven"t seen any side effects from the met, but I have noticed more normal bg's feel like lows to me because I'm used to higher numbers. Oh, I forgot to say I also have lost 2 pound this week. I finally broke the 130 plateau and was 129 this morning. I have this feeling my metabolism is working better. Hopefully it won't be temporary. I'm almost afraid to start exercising again ( I might gain weight) Last edited by jwags; 8/18/09 at Continue reading >>

Metformin

Metformin

Adult Dosing . Dosage forms: TAB: 500 mg, 850 mg, 1000 mg; ER TAB: 500 mg, 750 mg, 1000 mg diabetes mellitus, type 2 [immediate-release form] Dose: 850-1000 mg PO bid; Start: 850 mg PO qd or 500 mg PO bid, incr. 500 mg qwk or 850 mg q2wk; Max: 2550 mg/day; Info: give w/ meals; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn [extended-release form] Dose: 1000-2000 mg ER PO qpm; Start: 500 mg ER PO qpm, incr. 500 mg/day qwk; Max: 2000 mg/day ER; Alt: 1000 mg ER PO bid; Info: may add 500 mg regular form if inadequate response; give w/ meals; do not cut/crush/chew ER tab; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn *polycystic ovary syndrome [immediate-release form] Dose: 500 mg PO tid; Max: 2550 mg/day; Alt: 850-1000 mg PO bid; Info: may incr. dose if inadequate response; give w/ meals; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn [extended-release form] Dose: 1500-2000 mg ER PO qpm; Info: give w/ meals; do not cut/crush/chew ER tab; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn renal dosing [see below] eGFR 30-45: avoid use; eGFR <30: contraindicated hepatic dosing [see below] hepatic impairment: avoid use Continue reading >>

Metformin, Oral Tablet

Metformin, Oral Tablet

Metformin oral tablet is available as both a generic and brand-name drug. Brand names: Glucophage, Glucophage XR, Fortamet, and Glumetza. Metformin is also available as an oral solution but only in the brand-name drug Riomet. Metformin is used to treat high blood sugar levels caused by type 2 diabetes. FDA warning: Lactic acidosis warning This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects. Lactic acidosis is a rare but serious side effect of this drug. In this condition, lactic acid builds up in your blood. This is a medical emergency that requires treatment in the hospital. Lactic acidosis is fatal in about half of people who develop it. You should stop taking this drug and call your doctor right away or go to the emergency room if you have signs of lactic acidosis. Symptoms include tiredness, weakness, unusual muscle pain, trouble breathing, unusual sleepiness, stomach pains, nausea (or vomiting), dizziness (or lightheadedness), and slow or irregular heart rate. Alcohol use warning: You shouldn’t drink alcohol while taking this drug. Alcohol can affect your blood sugar levels unpredictably and increase your risk of lactic acidosis. Kidney problems warning: If you have moderate to severe kidney problems, you have a higher risk of lactic acidosis. You shouldn’t take this drug. Liver problems warning: Liver disease is a risk factor for lactic acidosis. You shouldn’t take this drug if you have liver problems. Metformin oral tablet is a prescription drug that’s available as the brand name drugs Glucophage, Glucophage XR, Fortamet, and Glumetza. Glucophage is an immediate-release tablet. All of the other brands are extended-r Continue reading >>

Metformin Dosage

Metformin Dosage

Metformin Dosage There have been no human studies to identify the optimal dose of metformin that is needed to duplicate the beneficial gene expression effects that are described in the June 2003 issue of Life Extension magazine. For people who want to derive the many proven health benefits of metformin, it might be prudent to follow the dosage schedule used by Type II diabetics. According to the Physician's Desk Reference, the starting dose should be 500 mg of metformin twice a day. (An alternative option is 850 mg of metformin once a day). After one week, increase the dose of metformin to 1000 mg as the first dose of the day and 500 mg as the second dose. After another week, increase to 1000 mg of metformin two times a day. The maximum safe dose described in the Physician's Desk Reference is 2550 mg a day (which should be taken as 850 mg three times a day). According to the Physician's Desk Reference, clinically significant responses in Type II diabetics are not seen at doses below 1500 mg a day of metformin. Anti-aging doctors, on the other hand, have recommended doses as low as 500 mg twice a day to healthy non-diabetics who are seeking to obtain metformin's other proven benefits such as enhancing insulin sensitivity and reducing excess levels of insulin, glucose, cholesterol and triglycerides in the blood. It could be the dosage range is highly individualistic in healthy people, meaning some may benefit from 500 mg twice a day, while others may need 1000 mg twice a day for optimal effects. Blood tests to ascertain if the dose of metformin you are taking is improving glucose/insulin metabolism would be: Hemoglobin A1c Fasting insulin CBC/Chemistry panel that includes glucose, cholesterol triglycerides and indicators of liver and kidney function A hemoglobin A1c test Continue reading >>

High-dose Metformin Safe, Effective In Japanese Adults With Type 2 Diabetes

High-dose Metformin Safe, Effective In Japanese Adults With Type 2 Diabetes

In Japanese adults with poorly controlled type 2 diabetes, high doses of metformin administered twice or three times daily improved fasting plasma glucose and 24-hour glycemic profile in a dose-dependent fashion, according to findings reported in the Journal of Diabetes Investigation. “While the usual dosage of metformin is over 2,000 mg per day in Europe and the USA, the maximum dose allowed for clinical use in Japan has long been limited to 750 mg per day, which is less than half that of Western countries,” Hiroshi Ikegami, MD, PhD, of the department of endocrinology, metabolism and diabetes at Kindai University in Osaka, Japan, and colleagues wrote. “In addition, the recommended prescription of the maximum dose of metformin in Japan (750 mg per day) has been via 250-mg tablets administered three times per day. ... These differences in dosage and dosing frequency of metformin between Japan and Western countries have made it difficult to translate the results of clinical trials in Western countries to Japanese patients.” In two prospective studies, Ikegami and colleagues analyzed data from 71 Japanese patients with type 2 diabetes recruited between August 2011 and October 2016 from Kindai University Hospital (39 men; mean age, 61 years; mean BMI, 27 kg/m²; mean diabetes duration, 8.4 years; mean FPG, 7.5 mmol/L). All patients were provided standard meals recommended by the Japan Diabetes Society, and treatment with metformin was not initiated until patient FPG reached 11 mmol/L or less, to minimize the confounding effect of an initial improvement in glycemic control due to hospitalization. In the total cohort, 14 patients were treated with metformin monotherapy, whereas 54 patients were prescribed metformin as an add-on therapy to other antidiabetes medication Continue reading >>

Metformin: Indication, Dosage, Side Effect, Precaution | Mims.com Malaysia

Metformin: Indication, Dosage, Side Effect, Precaution | Mims.com Malaysia

Adult : PO Conventional preparation: Initial: 500 mg bid or tid, or 850 mg 1-2 times daily, may increase gradually to 2000-3000 mg/day at intervals of at least 1 wk. Modified-release preparation: Initial: 500 mg once daily, may increase in increments of 500 mg at intervals of at least 1 wk to max 2000 mg once daily at night. If glycaemic control is not sufficient, dose may be divided to give 1000 mg bid. Doses >2000 mg/day, admin the conventional preparation. Adult: Conventional preparation: Initially, 500 mg bid or tid, or 850 mg 1-2 times daily, may increase gradually to 2000-3000 mg daily at intervals of at least 1 wk. Modified-release preparation: Initially, 500 mg once daily, may increase in increments of 500 mg at intervals of at least 1 wk to max 2000 mg once daily at night. If glycaemic control is not sufficient, dose may be divided to give 1000 mg bid. Doses >2000 mg daily, admin the conventional preparation. Child: 10 yr Initially, 500 mg 1-2 times daily or 850 mg once daily, may increase gradually to max 2000 mg daily in 2 or 3 divided doses at intervals of at least 1 wk. Elderly: Initial and maintenance dosing should be conservative. Patient w/ acute or chronic metabolic acidosis, including diabetic ketoacidosis w/ or w/o coma; undergoing surgery. Intravascular admin of iodinated contrast agents. Renal impairment (CrCl <60 mL/min). Patient w/ CHF requiring drug therapy, cardiac or resp failure, recent MI, shock. Patient exposed to stress-related states (e.g. fever, trauma, infection, surgery). Hepatic impairment. Elderly. Pregnancy and lactation. Anorexia, nausea, vomiting, diarrhoea, abdominal pain, taste disturbance, hepatitis. Rarely, decreased vit B12 absorption, erythema, pruritus and urticaria. Category B: Either animal-reproduction studies have not d Continue reading >>

Proper Use

Proper Use

Drug information provided by: Micromedex This medicine usually comes with a patient information insert. Read the information carefully and make sure you understand it before taking this medicine. If you have any questions, ask your doctor. Carefully follow the special meal plan your doctor gave you. This is a very important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed. Metformin should be taken with meals to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment. Swallow the extended-release tablet whole with a full glass of water. Do not crush, break, or chew it. While taking the extended-release tablet, part of the tablet may pass into your stool after your body has absorbed the medicine. This is normal and nothing to worry about. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way. You may notice improvement in your blood glucose control in 1 to 2 weeks, but the full effect of blood glucose control may take up to 2 to 3 months. Ask your doctor if you have any questions about this. Dosing The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the Continue reading >>

Glucophage, Glucophage Xr (metformin) Dosing, Indications, Interactions, Adverse Effects, And More

Glucophage, Glucophage Xr (metformin) Dosing, Indications, Interactions, Adverse Effects, And More

Initial: 500 mg PO q12hr or 850 mg PO qDay with meals; increase q2Weeks Maintenance: 1500-2550 mg/day PO divided q8-12hr with meal Glucophage XR: 500 mg PO qDay with dinner; titrate by 500 mg/day qWeek; not to exceed 2000 mg/day Fortamet: 500-1000 mg PO qDay; titrate by 500 mg/day qWeek; not to exceed 2500 mg/day Glumetza: 1000 mg PO qDay; titrate by 500 mg/day qWeek; not to exceed 2000 mg/day Hepatic impairment: Avoid use; risk of lactic acidosis eGFR 30-45 mL/min/1.73 m: Not recommended to initiate treatment Monitor eGFR at least annually or more often for those at risk for renal impairment (eg, elderly) If eGFR falls below 45mL/min/1.73 m while taking metformin, risks and benefits of continuing therapy should be evaluated If eGFR falls below 30 mL/min/1.73 m: while taking metformin, discontinue the drug Orphan designation for treatment of pediatric polycystic ovary syndrome EffRx Pharmaceuticals SA; Wolleraustrass 41 B; 8807 Freienbach (SZ); SWITZERLAND Orphan designation for treatment of progressive myoclonus epilepsy type 2 (Lafora disease) Consorcio Centro de Investigacin Biomdica en Red, M.P. (CIBER); Monforte de Lemos, 3-5 Pabellon 11; Madrid, Spain Maintenance: Titrate qWeek by 500 mg; no more than 2000 mg/day in divided doses Initial: 500 mg PO q12hr or 850 mg PO qDay with meals; increase q2Weeks Maintenance: 1500-2550 mg/day PO divided q8-12hr with meal Glucophage XR: 500 mg PO qDay with dinner; titrate by 500 mg/day qWeek; not to exceed 2000 mg/day Fortamet: 500-1000 mg PO qDay; titrate by 500 mg/day qWeek; not to exceed 2500 mg/day eGFR 30-45 mL/min/1.73 m: Initiating not recommended Obtain GFR at least annually in all patients taking metformin; assess eGFR more frequently in patients at increased risk for renal impairment (eg, elderly) If eGFR falls to <4 Continue reading >>

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Abstract OBJECTIVE Metformin is the first-line oral medication recommended for glycemic control in patients with type 2 diabetes. We reviewed the literature to quantify the effect of metformin treatment on glycated hemoglobin (HbA1c) levels in all types of diabetes and examine the impact of differing doses on glycemic control. RESEARCH DESIGN AND METHODS MEDLINE, EMBASE, and the Cochrane Library were searched from 1950 to June 2010 for trials of at least 12 weeks’ duration in which diabetic patients were treated with either metformin monotherapy or as an add-on therapy. Data on change in HbA1c were pooled in a meta-analysis. Data from dose-comparison trials were separately pooled. RESULTS A total of 35 trials were identified for the main analysis and 7 for the dose-comparison analysis. Metformin monotherapy lowered HbA1c by 1.12% (95% CI 0.92–1.32; I2 = 80%) versus placebo, metformin added to oral therapy lowered HbA1c by 0.95% (0.77–1.13; I2 = 77%) versus placebo added to oral therapy, and metformin added to insulin therapy lowered HbA1c by 0.60% (0.30–0.91; I2 = 79.8%) versus insulin only. There was a significantly greater reduction in HbA1c using higher doses of metformin compared with lower doses of metformin with no significant increase in side effects. CONCLUSIONS Evidence supports the effectiveness of metformin therapy in a clinically important lowering of HbA1c used as monotherapy and in combination with other therapeutic agents. There is potential for using higher doses of metformin to maximize glycemic control in diabetic patients without increasing gastrointestinal effects. Metformin is the most commonly prescribed antihyperglycemic medication for diabetes in the U.S. (1) and the U.K. (2) and is the recommended first choice for oral therapy (2–4). T Continue reading >>

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