Metformin is available as a stand-alone pill and is also available in combination pills with several other types of oral medicines. In fact, the UKPDS is one of the major studies that lead the ADA and EASD to place metformin as the first-line therapy. In the large United Kingdom Prospective Diabetes Study (UKPDS), metformin was associated with better health outcomes than various other therapies, including chlorpropamide (brand name Diabinese), glibenclamide, also known as glyburide, (DiaBeta and others), or insulin, and was additionally associated with less weight gain and fewer episodes of hypoglycemia (low blood glucose). Large reviews of multiple studies have shown decreases in HbA1c (an indication of blood glucose control over the previous 2–3 months) from 1% to 2% in people using metformin. The joint guidelines issued by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) for the treatment of people with Type 2 diabetes call for metformin to be used as the first-line drug therapy along with lifestyle interventions (a healthful diet and exercise). As a result, both glucose and insulin levels in people with Type 2 diabetes decrease with metformin therapy. Additionally, the decrease in fatty acid levels brought about by metformin may indirectly improve insulin resistance and beta cell function. This protein acts much like an “energy sensor,” setting off cellular activities that result in glucose storage, enhanced entry of glucose into cells, and decreased creation of fatty acids and cholesterol.Ī secondary effect of the enhanced entry of glucose into cells is improved glucose uptake and increased storage of glycogen (a form of glucose) by the muscles. It does this by activating a protein known as AMP-activated protein kinase, or AMPK. Metformin works primarily by decreasing the amount of glucose made by the liver. (A finding that has been confirmed in many other clinical trials to date.) Of note, the FDA officer involved in removing phenformin from the market recently wrote an article highlighting the safety of metformin. Food and Drug Administration (FDA) required large safety studies of metformin, the results of which demonstrated that the development of lactic acidosis as a result of metformin therapy is very rare. (By comparison, metformin has been used in Europe since the 1960’s.) The U.S. This situation most likely slowed the approval of metformin, which was not used in the U.S. Unfortunately, phenformin was found to be associated with lactic acidosis, a serious and often fatal condition, and was removed from the U.S. This type of medicine was first introduced into clinical practice in the 1950’s with a drug called phenformin. Metformin (brand names Glucophage, Glucophage XR, Riomet, Fortamet, Glumetza) is a member of a class of medicines known as biguanides. Tune in on August 21 for the next installment. Editor’s Note: This is the second post in our miniseries about diabetes drugs.
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