title: Role of metformin in the initiation of pharmacotherapy for type 2 diabetes: an Asian-Pacific perspective.
abstract: Increases in the prevalence of type 2 diabetes of 30-60% will occur in many Asian-Pacific countries by 2025, driven by urbanisation, sedentary habits and energy-rich diets. Obesity, insulin resistance, metabolic syndrome and diabetes are closely interrelated. Optimal control of diabetes and associated risk factors has reduced the risk of diabetes-related complications. In the UK Prospective Diabetes Study (UKPDS), metformin reduced the risk of macrovascular complications and retrospective analyses have confirmed the efficacy of metformin in improving clinical outcomes in type 2 diabetic patients with a history of cardiovascular disease. This growing body of evidence has led to the recommendation of metformin as optimum initial pharmacotherapy in overweight type 2 diabetic patients. Obesity is less prevalent in the Asian-Pacific population than in Caucasian populations. Nevertheless, metformin has multiple beneficial metabolic effects, which provide sufficient rationale for it to be recommended as the initial oral anti-diabetic pharmacotherapy, alone or in combination, irrespective of body mass index. This recommendation is consistent with global guidelines and regional recommendations for the Asian-Pacific region from the International Diabetes Federation. These recommendations can serve as templates for development of local guidelines for Asian people with diabetes, given the ethnic and cultural diversity within the region.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hongkong. jchan@cuhk.edu.hk
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
authors.forename: Chaicharn
authors.initials: C
authors.lastname: Deerochanawong
authors.forename: A Samad
authors.initials: AS
authors.lastname: Shera
authors.forename: Kun-Ho
authors.initials: KH
authors.lastname: Yoon
authors.forename: John M F
authors.initials: JM
authors.lastname: Adam
authors.forename: Van Binh
authors.initials: VB
authors.lastname: Ta
authors.forename: Siew-Pheng
authors.initials: SP
authors.lastname: Chan
authors.forename: Richard Elwyn
authors.initials: RE
authors.lastname: Fernando
authors.forename: Lee Chung
authors.initials: LC
authors.lastname: Horn
authors.forename: Thy Khue
authors.initials: TK
authors.lastname: Nguyen
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Litonjua
authors.forename: Sidartawan
authors.initials: S
authors.lastname: Soegondo
authors.forename: Paul
authors.initials: P
authors.lastname: Zimmet
mesh_terms: D001208:Asia / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008687:Metformin / Q000627:therapeutic use*; D015995:Prevalence
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D008687:Metformin