Summaries for Patients |

Metformin for Patients with Type 2 Diabetes Mellitus FREE

[+] Article, Author, and Disclosure Information

The summary below is from the full report titled “Metformin: An Update.” It is in the 2 July 2002 issue of Annals of Internal Medicine (volume 137, pages 25-33). The authors are D Kirpichnikov, SI McFarlane, and JR Sowers.

Ann Intern Med. 2002;137(1):I-50. doi:10.7326/0003-4819-137-1-200207020-00004
Text Size: A A A

What is the problem and what is known about it so far?

Diabetes mellitus is a disease characterized by high levels of sugar (glucose) in the blood. Insulin (a chemical produced by the pancreas) helps regulate the level of glucose in the blood by facilitating its passage into the cells of the body, where it is used as a nutrient. When glucose enters cells, it is effectively removed from the blood and its concentration in the bloodstream decreases. Two types of diabetes mellitus are recognized. Type 1 (juvenile) diabetes is caused by a failure of the pancreas to produce insulin, while type 2 (adult-onset or non-insulin-dependent) diabetes results from resistance of cells to respond to insulin's usual effects. Although extra insulin output initially overcomes cells' resistance, the pancreas eventually fails to produce enough to do the job effectively. Many experts believe that type 2 diabetes is one component of a “metabolic syndrome” that includes obesity, cholesterol disorders, hypertension, and blood clotting abnormalities.

Why did the authors do this update?

To update doctors on the effectiveness of metformin, a drug used to treat high blood sugar and other components of the metabolic syndrome.

How did the authors do this update?

They looked at numerous studies that followed patients treated with metformin alone or in combination with other drugs and articles dealing with the metabolic syndrome.

What did the authors find?

Metformin is effective in decreasing cells' resistance to insulin. By itself, metformin is as effective as another group of drugs used to lower blood sugar (sulfonylureas), and when used along with diet modification, it substantially reduces the fasting blood sugar level. When taken in combination with other agents, it is frequently more effective than any single drug used to lower blood glucose levels.

The exact way metformin works is unclear, but the drug also appears to improve or correct other conditions associated with the metabolic syndrome, such as high fat levels in the blood, the way calcium enters cells, blood clotting abnormalities, and obesity. When compared with conventional diabetes therapy, metformin significantly reduces the risk for heart attack, diabetes-related death, and overall death. Metformin is especially well suited for treatment of obese diabetic persons with normal kidney function. The drug may not be appropriate for thin elderly patients.

Dose of the drug should be increased gradually to allow the body to adjust to its effects. Common side effects are nausea and diarrhea, which usually disappear within 2 weeks. Metformin may be associated with a life-threatening buildup of lactic acid in the blood (lactic acidosis) and is not appropriate for people with liver failure, a history of alcohol abuse, or active infections.

What are the implications of this update?

Physicians should consider prescribing metformin, alone or in combination with other therapies, for patients with type 2 diabetes mellitus, particularly those who are obese and have normal kidney function.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.