METFORMIN - A NEW TREATMENT OPTION FOR NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Metformin is a biguanide that can used alone or in combination with su lfonylureas or insulin in the treatment of non-insulin-dependent diabe tes mellitus (NIDDM). Since biguanides do not increase pancreatic insu lin secretion, they are referred to as antihyperglycemic agents, as op posed to hypoglycemic agents. Biguanides reduce hyperglycemia by incre asing insulin sensitivity, decreasing glucose absorption, and inhibiti ng hepatic gluconeogenesis. Advantages of metformin include achieving glycemic control without exacerbating weight gain or hyperinsulinemia and beneficially affecting serum cholesterol concentrations. Although metformin has the potential to cause lactic acidosis, thr incidence is significantly lower compared with phenformin. Risk factors for lactic acidosis include renal serum creatinine >1.5 mg/dL and cardiovascular , pulmonary, and hepatic disease. Metformin should be temporarily disc ontinued prior to surgery and before administration of radiologic intr a venous contrast, and in patients with sepsis, severe gastrointestina l disease, trauma, and acute cardiovascular events.