| A risk-benefit assessment of metformin in type 2 diabetes mellitus. | |
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MedLine Citation:
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PMID: 10392666 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Metformin has been used for over 40 years as an effective glucose-lowering agent in type 2 (noninsulin-dependent) diabetes mellitus. Typically it reduces basal and postprandial hyperglycaemia by about 25% in more than 90% of patients when either given alone or coadministered with other therapies including insulin during a programme of managed care. Metformin counters insulin resistance and offers benefits against many features of the insulin resistance syndrome (Syndrome X) by preventing bodyweight gain, reducing hyperinsulinaemia and improving the lipid profile. In contrast to sulphonylureas, metformin does not increase insulin secretion or cause serious hypoglycaemia. Treatment of type 2 diabetes mellitus with metformin from diagnosis also offers greater protection against the chronic vascular complications of type 2 diabetes mellitus. The most serious complication associated with metformin is lactic acidosis which has an incidence of about 0.03 cases per 1000 patients years of treatment and a mortality risk of about 0.015 per 1000 patient-years. Most cases occur in patients who are wrongly prescribed the drug, particularly patients with impaired renal function (e.g. serum creatinine level > 130 micromol/L or > 1.5 g/L). Other major contraindications include congestive heart failure, hypoxic states and advanced liver disease. Serious adverse events with metformin are predictable rather than spontaneous and are potentially preventable if the prescribing guidelines are respected. Gastrointestinal adverse effects, notably diarrhoea, occur in less than 20% of patients and remit when the dosage is reduced. The life-threatening risks associated with metformin are rare and could mostly be avoided by strict adherence to the prescribing guidelines. Given the 4 decades of clinical experience with metformin, its antihyperglycaemic efficacy and benefits against Syndrome X, metformin offers a very favourable risk-benefit assessment when compared with the chronic morbidity and premature mortality among patients with type 2 diabetes mellitus. |
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Authors:
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H C Howlett; C J Bailey |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Drug safety : an international journal of medical toxicology and drug experience Volume: 20 ISSN: 0114-5916 ISO Abbreviation: Drug Saf Publication Date: 1999 Jun |
Date Detail:
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Created Date: 1999-08-17 Completed Date: 1999-08-17 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 9002928 Medline TA: Drug Saf Country: NEW ZEALAND |
Other Details:
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Languages: eng Pagination: 489-503 Citation Subset: IM |
Affiliation:
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Clinical Research, Merck Lipha, West Drayton, England. HHowlett@merck-lipha.co.uk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acidosis, Lactic
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chemically induced Body Weight / drug effects Diabetes Mellitus, Type 2 / drug therapy* Female Glucose / metabolism Humans Hypoglycemic Agents / adverse effects, contraindications, therapeutic use* Insulin Resistance Male Metformin / adverse effects, contraindications, therapeutic use* Middle Aged Risk Assessment |
| Chemical | |
Reg. No./Substance:
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0/Hypoglycemic Agents; 50-99-7/Glucose; 657-24-9/Metformin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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