The 'slower' the better

Autor: C. M. Rotella, L. Pala
Rok vydání: 2014
Předmět:
Zdroj: Journal of Endocrinological Investigation
ISSN: 1720-8386
Popis: A new formulation of metformin: metformin extended-release (ER) is now available, with different formulations in each country and it appears relevant to discuss the management of this drug in clinical practice. Metformin, an oral biguanide hypoglycemic agent, is an efficacious tool in the treatment of type 2 diabetes mellitus. Metformin’s efficacy, security profile, benefic cardiovascular and metabolic effects make this drug as the first agent of choice in the treatment of type 2 diabetes, together with lifestyle modifications [1]. Type 2 diabetes is characterized by impaired insulin secretion and insulin resistance. Insulin resistance in the fasting state induces an increase in hepatic gluconeogenesis and induces hyperglycemia in the early morning. Metformin, as its major effect, decreases hepatic glucose output lowering fasting glycaemia and, secondarily, it increases glucose uptake in peripheral tissues. It is generally well tolerated, despite the fact that the most common adverse effects are gastrointestinal ones, which may be tampered by dose titration. In monotherapy metformin decreases HbA1c levels by 0.6–1.0 % and this is not accompanied by hypoglycemia in the large majority of patients. Metformin is neutral with respect to weight or, possibly, induces a modest weight loss. The UKPDS has demonstrated a beneficial effect of metformin therapy on CVD outcomes [2]. Severe renal dysfunction is considered a contraindication to metformin use, because it may increase the risk of lactic acidosis; therefore, therapy should be discontinued if the estimated glomerular filtration rate falls below 30 ml/min. The pharmacokinetic characteristics of the conventional immediate-release (IR) formulation of metformin need three times daily dosing. Metformin is primarily used to treat type 2 diabetes, but it is also beneficial in the treatment of other metabolic diseases such as the polycystic ovarian syndrome (PCOS) and the non alcoholic fat liver disease (NAFLD).
Databáze: OpenAIRE
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