title: Metformin therapy and clinical uses.
abstract: Metformin is now established as a first-line antidiabetic therapy for the management of type 2 diabetes. Its early use in treatment algorithms is supported by lack of weight gain, low risk of hypoglycaemia and its mode of action to counter insulin resistance. The drug's anti-atherosclerotic and cardioprotective effects have recently been confirmed in prospective and retrospective studies, and appear to reflect a collection of glucose-independent effects on the vascular endothelium, suppressant effects on glycation, oxidative stress and formation of adhesion molecules, stimulation of fibrinolysis and favourable effects on the lipid profile. Although avoidance of troublesome gastrointestinal tolerability issues requires careful dose titration, the risk of serious adverse events is considered low provided that contra-indications (especially with respect to renal function) are observed. As many of its actions go beyond glucose lowering, emerging evidence indicates potential benefits in other insulin-resistant states and possibly tumour suppression.
authors.affiliation: Department of Diabetes and Endocrinology, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK. john.scarpello@npsa.nhs.uk
authors.forename: John H B
authors.initials: JH
authors.lastname: Scarpello
authors.forename: Harry C S
authors.initials: HC
authors.lastname: Howlett
mesh_terms: D000284:Administration, Oral; D001786:Blood Glucose / Q000187:drug effects*; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008687:Metformin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D008687:Metformin