1
|
Raičević B, Janković S. Predictors of gastrointestinal complaints in patients on metformin therapy. Open Med (Wars) 2023; 18:20230871. [PMID: 38045859 PMCID: PMC10693010 DOI: 10.1515/med-2023-0871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023] Open
Abstract
Although being very effective in the treatment of diabetes and a few other conditions, metformin (MTF) cannot be tolerated by many patients due to gastrointestinal (GI) complaints. A number of risk factors for intolerance were identified, but many are still controversial or uninvestigated. The aim of this study was to further investigate possible risk factors for the occurrence of GI complaints in patients on MTF therapy. A cross-sectional design was used for this multicentric study on adult patients visiting 50 community pharmacies in Montenegro. The patients were surveyed by semi-structured questionnaire after a service of a pharmacist was delivered, and their drugs dispensed. Uni- and multi-variate regression methods were used for processing the data. In total 330 patients participated in the study. A higher body mass index (OR = 1.113, p = 0.003), living at a higher altitude (OR = 1.725, p = 0.000), anaemia (OR = 4.221, p = 0.008), and intestinal infection in the last 3 months (OR = 2.801, p = 0.006) increased the risk of GI complaints in patients on MTF therapy, while the use of statins was protective (OR = 0.204, p = 0.016). Each case of MTF intolerance should be carefully investigated for risk and protective factors, which could be potentially eliminated or augmented, respectively, and MTF withdrawal avoided.
Collapse
Affiliation(s)
- Branislava Raičević
- Clinical Pharmacology, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia
| | - Slobodan Janković
- Pharmacology and Toxicology Department, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
2
|
Alibrahim NTY, Chasib MG, Hamadi SS, Mansour AA. Predictors of Metformin Side Effects in Patients with Newly Diagnosed Type 2 Diabetes Mellitus. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2023. [DOI: 10.1055/s-0043-1761215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Abstract
Introduction Metformin has become the first-line agent for the treatment of type 2 diabetes mellitus (T2DM) in several international guidelines. Up to 25% of patients suffer from gastrointestinal side-effects, with approximately 5% unable to tolerate metformin at all.
Objective We aimed to study the effect of variables that may influence the development of metformin side effects and/or intolerance.
Method A prospective study was conducted from April 1, 2021 to March 30, 2022. One-hundred and forty-eight patients newly diagnosed with T2DM were enrolled in the study, and divided into two groups—those who were escalate to the maximum dose of metformin over 2 weeks (n = 43) and the other group over 4 weeks (n = 105). We studied the variables that may affect the development of side effects including age, gender, body mass index (BMI), lipid profile, glycemic level, and the use of other antidiabetic medications besides the duration of dose escalation.
Results Total number of patients who developed side effects was 59 (39.9%). Twenty-four (55.8%) and 35 (33.3%) patients were put in the rapid and slow escalation groups, respectively. Twenty-six (17.6%) patients developed diarrhea that was the most common side effect. Two (2.7%) men and ten women (13.5%) had stopped metformin due to severe side effects developed after initiation (p = 0.016). The mean BMI for the patients who discontinued metformin was 34.7 ± 4.1 kg/m2 in the rapid escalation arm and 31.6 ± 3.3 kg/m2 in the slow escalation arm (p = 0.003). The mean of fasting blood glucose for the patients who discontinued metformin in the rapid and slow escalation arms was 200.6 ± 25.6 and 173.4 ± 36.5 mg/dL, respectively (p = 0.022).
Conclusion The severity of metformin side effects is higher in women than in men, making more women to discontinue the drug. Besides, a higher fasting blood sugar and BMI are associated with a higher rate of discontinuation. A rapid dose escalation is associated with a higher frequency of side effects. Diarrhea is the commonest side effect encountered.
Collapse
Affiliation(s)
| | - Mohammed Ghazi Chasib
- Faiha Specialized Diabetes, Endocrine and Metabolism Center, University of Basrah, Basrah, Iraq
| | | | - Abbas Ali Mansour
- Faiha Specialized Diabetes, Endocrine and Metabolism Center, University of Basrah, Basrah, Iraq
| |
Collapse
|
3
|
Chen L, Chen Q, Chen X, Zhu P, Chen M, Wang W, Ye S, Zheng M. Clinical Application of Metformin Use in Anhui Province, China: A Cross-Sectional Study. J Multidiscip Healthc 2023; 16:345-354. [PMID: 36776727 PMCID: PMC9912819 DOI: 10.2147/jmdh.s397061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
Purpose Given the importance of metformin, reasonable utilization is essential. We designed a cross-sectional survey on physicians' attitude and clinical application of metformin in Anhui Province, China. Methods The survey was distributed via an electronic questionnaire among endocrinologists and general practitioners. Seven representative questions were used to evaluate professional levels. Results Among the 477 valid responses, 72.75% of the respondents preferred to prescribe metformin extended-release, while only 34.38% of them would prescribe metformin extended-release at the correct frequency. More than half of the respondents thought that estimated glomerular filtration rate ˂ 45 mL/min/1.73 m² should be the contraindication of metformin prescription. Less than 10% of the physicians selected correct responses for two questions regarding metformin usage and contrast agent. Physicians with higher levels of hospital grades, education background and professional titles as well as working in general hospitals and in the Department of Endocrinology achieved high scores (P˂0.05). Logistic regression showed that department was an independent predictor for high scores. Conclusion Physicians, especially non-endocrinologists, are not at a professional level for prescribing metformin. Physicians should be highly vigilant in terms of standardized prescription for metformin. The guidelines or consensuses about diabetes care for physicians should be promoted.
Collapse
Affiliation(s)
- Li Chen
- Department of Endocrinology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei City), Hefei, People's Republic of China
| | - Qin Chen
- Department of Pharmacy, Taihe County People's Hospital, Taihe, People's Republic of China
| | - Xueping Chen
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei, People's Republic of China.,Psychopharmacology Research Laboratory, Anhui Mental Health Center and Department of Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Pengli Zhu
- Department of Pharmacy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Meinan Chen
- Ethics Committee on Medical Research, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Wei Wang
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.,Laboratory of Diabetes, Department of Endocrinology, The First Affiliated Hospital of USTC, Hefei, People's Republic of China
| | - Shandong Ye
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.,Laboratory of Diabetes, Department of Endocrinology, The First Affiliated Hospital of USTC, Hefei, People's Republic of China
| | - Mao Zheng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.,Laboratory of Diabetes, Department of Endocrinology, The First Affiliated Hospital of USTC, Hefei, People's Republic of China
| |
Collapse
|
4
|
Sang M, Wu T, Zhou X, Horowitz M, Jones KL, Qiu S, Guo H, Wang B, Wang D, Rayner CK, Sun Z. Prevalence of Gastrointestinal Symptoms in Chinese Community-Dwelling Adults with and without Diabetes. Nutrients 2022; 14:nu14173506. [PMID: 36079764 PMCID: PMC9459935 DOI: 10.3390/nu14173506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Gastrointestinal symptoms have been reported to occur frequently in diabetes, but their prevalence in Chinese community-dwelling individuals with diabetes is unknown. The present study aimed to address this issue and explore the risk factors for gastrointestinal symptoms. Methods: A total of 1304 community-dwelling participants (214 with diabetes, 360 with prediabetes and 730 with normoglycemia) were surveyed for gastrointestinal symptoms using the Diabetes Bowel Symptom Questionnaire. Logistic regression analyses were applied to identify risk factors for gastrointestinal symptoms. Results: Of the overall study population, 18.6% reported at least one gastrointestinal symptom, without a significant difference between subjects with normoglycemia (17.7%), prediabetes (19.7%) and diabetes (20.1%). In all three groups, lower gastrointestinal symptoms, particularly diarrhea and constipation, were the most frequent. There was an interaction between age (≥65 years) and diabetes on the prevalence of at least one gastrointestinal symptom (p = 0.01) and of constipation (p = 0.004), with these being most frequent in subjects with diabetes aged ≥ 65 years. After multivariable adjustment, female gender and older age were associated with increased odds of at least one gastrointestinal symptom, specifically lower gastrointestinal symptoms. Older age was also associated with an increase in upper gastrointestinal symptoms. Conclusions: Gastrointestinal symptoms are common in Chinese community-dwelling adults with and without diabetes. Females, and the elderly with diabetes, are at an increased risk of symptoms.
Collapse
Affiliation(s)
- Miaomiao Sang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
| | - Tongzhi Wu
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Xiaoying Zhou
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
| | - Michael Horowitz
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Karen L. Jones
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Shanhu Qiu
- Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
| | - Haijian Guo
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Bei Wang
- Key Laboratory of Environmental Medicine and Engineering Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Donglei Wang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
| | - Christopher K. Rayner
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Correspondence: (C.K.R.); (Z.S.); Tel.: +86-025-8326-2818 (Z.S.); Fax: +86-025-8326-2609 (Z.S.)
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing 210009, China
- Correspondence: (C.K.R.); (Z.S.); Tel.: +86-025-8326-2818 (Z.S.); Fax: +86-025-8326-2609 (Z.S.)
| |
Collapse
|
5
|
Asgharnezhad M, Joukar F, Fathalipour M, Khosousi M, Hassanipour S, Pourshams A, Mansour-Ghanaei R, Mansour-Ghanaei F. Gastrointestinal symptoms in patients with diabetes mellitus and non-diabetic: A cross-sectional study in north of Iran. Diabetes Metab Syndr 2019; 13:2236-2240. [PMID: 31235163 DOI: 10.1016/j.dsx.2019.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Gastrointestinal (GI) symptoms are common in patients with diabetes mellitus (DM), which involved in high cost of health care and low quality of life. The aim of this study to investigate the prevalence of GI symptoms in diabetic patients referred to the Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences (Rasht, Iran) using a validated questionnaire. METHODS In this descriptive, cross-sectional study, 255 diabetic patients and 255 non-diabetic subjects were recruited. Participants were randomly selected. The questionnaire recorded GI symptoms among the study population. RESULTS GI symptoms were reported in 91.4% of diabetic patients, and 42.1% of them were male. The common GI symptoms in diabetic patients were flatulence (33.0%), followed by retrosternal pain (14.9%), belching (13.7%), postprandial fullness (12.5%), and constipation (11.4%). Retrosternal pain, constipation, flatulence, loss of appetite, and abdominal distention were more prevalent in diabetic women than men. CONCLUSIONS DM is associated with high prevalence rate of upper and lower GI symptoms. This effect may be linked to gender and poor glycemic control in diabetic patients, but not to type and duration of diabetes.
Collapse
Affiliation(s)
- Mehrnaz Asgharnezhad
- Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran; GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Fathalipour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammadjavad Khosousi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran; Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Akram Pourshams
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Mansour-Ghanaei
- Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran; Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| |
Collapse
|
6
|
Ji L, Liu J, Yang J, Li Y, Liang L, Zhu D, Li Q, Ma T, Xu H, Yang Y, Zeng J, Feng B, Qu S, Li Y, Ma L, Lin S, Wang J, Li W, Song W, Li X, Luo Y, Xi S, Lin M, Liu Y, Liang Z. Comparative effectiveness of metformin monotherapy in extended release and immediate release formulations for the treatment of type 2 diabetes in treatment-naïve Chinese patients: Analysis of results from the CONSENT trial. Diabetes Obes Metab 2018; 20:1006-1013. [PMID: 29227571 DOI: 10.1111/dom.13190] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
Abstract
AIMS Metformin treatment for type 2 diabetes mellitus (T2DM) can be limited by gastrointestinal (GI) adverse events (AEs), resulting in treatment discontinuation. We investigated whether once-daily metformin extended release (XR) is superior in terms of GI tolerability, with non-inferior efficacy, compared with thrice-daily metformin immediate release (IR) in treatment-naïve Chinese patients with T2DM. MATERIALS AND METHODS This prospective, open-label, randomized, multicentre, phase IV interventional study enrolled Chinese T2DM patients to receive either metformin XR or metformin IR with a 2-week screening period, a 16-week treatment period and a 2-week follow-up period without treatment. Co-primary endpoints were a non-inferiority assessment of metformin XR vs metformin IR in glycated haemoglobin (HbA1c) least squares mean (LSM) change from baseline to week 16 and the superiority of GI tolerability for metformin XR vs metformin IR. RESULTS Overall, 532 patients were randomized to metformin IR (n = 267) or metformin XR (n = 265). The HbA1c LSM change was -1.61% and -1.58% in each group, respectively (LSM difference, 0.03; 95% confidence interval [CI], -0.10, 0.17). Incidences of drug-related AEs were 26.5% (n = 66) in the metformin IR-only group and 32.2% (n = 85) in the metformin XR-only group, and GI AEs were 23.8% and 22.3% in each group, respectively (difference, -1.52; 95% CI, -8.60, 5.56). The treatment difference met the predefined non-inferiority upper CI margin of 0.4% in HbA1c. CONCLUSIONS Metformin XR was non-inferior to metformin IR for the LSM change in HbA1c from baseline to week 16 and not superior to metformin IR for overall GI AE incidence during treatment of Chinese T2DM patients.
Collapse
Affiliation(s)
- Linong Ji
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Jing Liu
- Department of Endocrinology, Gansu Provincial Hospital, Gansu, China
| | - Jing Yang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi, China
| | - Yufeng Li
- Department of Endocrinology, Beijing Pinggu Hospital, Beijing, China
| | - Li Liang
- Department of Endocrinology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital (the Affiliated Hospital of Nanjing University Medical School), Nanjing, China
| | - Quanmin Li
- Department of Endocrinology, General Hospital of the Rocket Forces of Chinese People's Liberation Army, Beijing, China
| | - Tianrong Ma
- Medical Affairs, Merck China Ltd, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Haiyan Xu
- Medical Affairs, Merck China Ltd, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Yanlan Yang
- Department of Endocrinology, Shanxi Provincial People's Hospital, Shanxi, China
| | - Jiaoe Zeng
- Department of Endocrinology, Jingzhou Central Hospital, Jingzhou, China
| | - Bo Feng
- Department of Endocrinology, Shanghai East Hospital Affiliated to Tongji University, Shanghai, China
| | - Shen Qu
- Department of Endocrinology, Shanghai Tenth People's Hospital (Tenth People's Hospital of Tongji University), Shanghai, China
| | - Yiming Li
- Department of Endocrinology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lizhen Ma
- Department of Endocrinology, Hangzhou First People's Hospital, Hangzhou, China
| | - Shanshan Lin
- Department of Endocrinology, Beijing Shijingshan Hospital, Beijing, China
| | - Jianping Wang
- Department of Endocrinology, The Second Hospital Affiliated to University of South China, Hengyang, China
| | - Wei Li
- Department of Endocrinology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Weihong Song
- Department of Endocrinology, Chenzhou No.1 People's Hospital, Chenzhou, China
| | - Xiaoxing Li
- Department of Endocrinology, The Third Hospital of Changsha, Changsha, China
| | - Yong Luo
- Department of Endocrinology, Chongqing Three Gorges Central Hospital, Chongqing, China
| | - Shugang Xi
- Department of Endocrinology, The First Hospital of Jilin University, Jilin, China
| | - Mei Lin
- Department of Endocrinology, Wuhan Puai Hospital, Wuhan, China
| | - Yu Liu
- Department of Endocrinology, Sir Run Run Hospital Nanjing Medical University, Nanjing, China
| | - Zerong Liang
- Department of Endocrinology, Chongqing Red Cross Hospital (People's Hospital of Jiangbei District), Chongqing, China
| |
Collapse
|
7
|
Bonnet F, Scheen A. Understanding and overcoming metformin gastrointestinal intolerance. Diabetes Obes Metab 2017; 19:473-481. [PMID: 27987248 DOI: 10.1111/dom.12854] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 12/22/2022]
Abstract
Metformin is the most widely prescribed drug for patients with type 2 diabetes mellitus and the first-line pharmacological option as supported by multiple international guidelines, yet a rather large proportion of patients cannot tolerate metformin in adequate amounts because of its associated gastrointestinal (GI) adverse events (AEs). GI AEs typically encountered with metformin therapy include diarrhoea, nausea, flatulence, indigestion, vomiting and abdominal discomfort, with diarrhoea and nausea being the most common. Although starting at a low dose and titrating slowly may help prevent some GI AEs associated with metformin, some patients are unable to tolerate metformin at all and it may also be difficult to convince patients to start metformin again after a bout of GI AEs. Despite this clinical importance, the underlying mechanisms of the GI intolerance associated with metformin are poorly known. In the present review, we discuss: the epidemiology of metformin-associated GI intolerance and its underlying mechanisms; genotype variability and associated factors affecting metformin GI intolerance, such as comorbidities, co-medications and bariatric surgery; clinical consequences and therapeutic strategies to overcome metformin GI intolerance. These strategies include appropriate titration of immediate-release metformin, use of extended-release metformin, the promise of delayed-release metformin and gut microbiome modulators, as well as alternative pharmacological therapies when metformin cannot be tolerated at all. Given the available data, all efforts should be made to maintain metformin before considering a shift to another drug therapy.
Collapse
Affiliation(s)
- Fabrice Bonnet
- Department of Endocrinology, Diabetes and Nutrition, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - André Scheen
- Department of Endocrinology, Diabetes and Nutrition, Division of Clinical Pharmacology, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, CHU, Liège, Belgium
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, University of Liège CHU, Liège, Belgium
| |
Collapse
|
8
|
Abstract
Metformin has been widely used for over 5 decades. New preparations have been developed for possible enhancement of efficiency, tolerability, and pleiotropic nonglycemic effects. Extended-release metformin has contributed to adherence and improved gastrointestinal tolerability. Delayed-release metformin acts in the lower gastrointestinal tract and exerts glucose-lowering effects at lower plasma metformin levels, which might suggest use of this biguanide in patients with chronic kidney disease. Metformin is also known to have numerous nonglycemic effects. Results of the UK Prospective Diabetes Study indicate improvements in cardiovascular outcome and reduced total mortality independent of glycemic control. Anticancer effects of metformin have been discussed and many clinical trials are on-going. Metformin is noted for its beneficial effects on lifespan extension and on disorders due to increased insulin resistance. Further investigations, including randomized control trials in nondiabetic individuals, are required to demonstrate the nonglycemic effects of metformin.
Collapse
Affiliation(s)
- Yoshihito Fujita
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| |
Collapse
|