METFORMIN - AN EFFECTIVE AND SAFE AGENT FOR INITIAL MONOTHERAPY IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Metformin hydrochloride (Glucophage[reg], Bristol Myers Squibb) is a b iguanide oral antihyperglycemic agent effective in treating non-insuli n dependent diabetes mellitus (NIDDM). Although metformin may be added to regimens containing sulfonylureas, it is also highly effective as initial monotherapy in patients with newly diagnosed NIDDM. Metformin reduces hepatic glucose production by decreasing gluconeogenesis, thus reducing hyperglycemia and improving glucose tolerance. It enhances i nsulin stimulated glucose utilization in peripheral tissues, particula rly skeletal muscle, as well as fat and intestinal tissue, without sti mulating insulin secretion. Metformin is superior in efficacy to place bo and comparable in efficacy to the sulfonylureas. However, metformin does not induce hypoglycemia Or body weight gain in lean or overweigh t patients. Metformin reduces insulinemia and has favorable effects on plasma lipid profiles, possibly diastolic blood pressure, and other e stablished cardiovascular disease risk factors. Metformin is well tole rated, with most adverse events being gastrointestinal and transient i n nature. Lactic acidosis, a significant risk with phenformin therapy, occurs very rarely with metformin. Thus, metformin is an effective an d well-tolerated initial treatment for NIDDM. In addition to having be neficial effects on glycemia and insulinemia, metformin, compared to o ther antidiabetic therapies, has a positive influence on lipid profile s and body weight.