Metformin: old wine in new bottle--evolving technology and therapy in diabetes

Metformin is the most common prescribed oral antidiabetic drug in the world. It shall continue to maintain its position despite of several other classes of oral agents have been recently introduced both as initial therapy and in combination with these newer drugs for prevention and treatment of type 2 diabetes mellitus (DM). The current review focuses on novel mechanism of action, efficacy, toxicity, administration of newer metformin formulation and technology of metformin. Metformin is a hepato-selective insulin sensitizer. It has beneficial properties of metformin including weight loss, lipid reduction and modulator of endothelial function. It is an atherostatic agent and also improves ovarian function in some insulin-resistant women. It does not cause hyperinsulinaemia or hypoglycaemia. Metformin is effective as monotherapy and, in combination with both insulin secretagogues and thiazolidinediones (TZDs) and may obviate the need for insulin treatment. Several fixed-dose combination pills containing metformin and other agents are available. Metformin remains a safe and effective agent for the therapy of patients with type 2 DM. It is still in most circumstances the agent of choice for first line initial therapy of the typical obese patient with type 2 DM and mild to moderate hyperglycaemia. With the current sustained release (XL) formulation of metformin, metformin therapy has now upgraded itself from the Gold Standard to Platinum. These unique XL bioequivalent metformin preparations will become the platinum standards in modern diabetes management.