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Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Insulin: Dosing Regimen and Adverse Effects01:16

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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Carbohydrate metabolism is a fundamental biochemical process that ensures a constant supply of energy to living cells. The most important carbohydrate is glucose, which can be broken down via glycolysis to enter into the Krebs cycle and eventually lead to the production of ATP through oxidative phosphorylation.
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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
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Diabetes: Management and Pharmacotherapy01:15

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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[CME: Metformin - Dos and Don'ts].

Lea Slahor1

  • 1Departement Medizin, Luzerner Kantonsspital, Luzern.

Praxis
|December 8, 2021
PubMed
Summary

Metformin is a first-line medication for type 2 diabetes, offering glycemic control and weight reduction without hypoglycemia risk. Careful monitoring of kidney function is crucial to prevent rare but serious lactic acidosis.

Area of Science:

  • Endocrinology
  • Pharmacology

Background:

  • Metformin remains a cornerstone initial therapy for type 2 diabetes mellitus (T2DM).
  • Despite evolving diabetes treatment landscapes, metformin's efficacy and safety profile persist.
  • It is widely used in monotherapy and combination treatments for T2DM management.

Purpose of the Study:

  • To review the indications and contraindications of metformin therapy in T2DM.
  • To highlight the benefits and risks associated with metformin use.
  • To emphasize the importance of dose adjustment based on estimated glomerular filtration rate (eGFR).

Main Methods:

  • Review of current clinical guidelines and pharmacological data on metformin.
  • Analysis of metformin's mechanism of action, efficacy, and safety profile.
Keywords:
Diabetes mellitusIndikationen und KontraindikationenMetformindiabetes mellitusindication and contraindication

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  • Identification of patient populations and conditions requiring metformin dose adjustment or contraindication.

    • Main Results:

    • Metformin improves glycemic control by inhibiting hepatic gluconeogenesis and enhancing peripheral insulin sensitivity.
    • Advantages include modest weight reduction, no hypoglycemia risk, good tolerability, established safety, and low cost.
    • Key risks include gastrointestinal side effects, potential vitamin B12 deficiency, and rare but life-threatening metformin-associated lactic acidosis (MALA), particularly with renal impairment.

    Conclusions:

    • Metformin is a valuable first-line agent for T2DM, offering significant benefits.
    • Strict adherence to contraindications, especially regarding renal function (eGFR <30 ml/min/1.73 m2), liver disease, and alcohol abuse, is essential.
    • Awareness of indications, contraindications, and potential side effects ensures safe and effective metformin utilization.