Metformin

Original Editor - Ashton Randolph

Top Contributors - Lucinda hampton and Ashton Randolph  

Introduction[edit | edit source]

Metformin 500mg Tablets.jpeg

Metformin is an antidiabetic agent used in type 2 diabetes. Metformin comes in both immediate-release and extended-release and is used in several combination products with other antidiabetic agents. Metformin also has several off-label-approved indications, including gestational diabetes, management of antipsychotic-induced weight gain, type 2 diabetes prevention, and the treatment and prevention of polycystic ovary syndrome (PCOS). Today, metformin is the only ADA-recommended antidiabetic for pre-diabetes. Possible potential indications include antiaging, anticancer, and neuroprotective effects[1].

  • Metformin is on the World Health Organisation’s List of Essential Medicines needed for a basic health care system.[2]
  • In Australia, approximately two-thirds of patients with type 2 diabetes are prescribed metformin, either alone or in combination with other pills, or with insulin injections.[3]

Action[edit | edit source]

Metformin reduces blood glucose levels by decreasing glucose production in the liver, decreasing intestinal absorption, and increasing insulin sensitivity.Metformin decreases both basal and postprandial blood glucose.[3] Metformin is considered weight neutral with the potential for modest weight loss. It is also unlikely to cause hypoglycemia and may be potentially cardioprotective.[1]

Administration[edit | edit source]

Metformin is an oral medication typically dosed from 500 to 2550 mg per day and administered with a meal to decrease GI upset. The daily dose is often titrated weekly in increments of 500 mg or 850 mg to reduce this risk. Depending on the form, it is taken once to three times daily.[3]

Adverse Effects[edit | edit source]

Metformin does not cause excessive hypoglycemia, which is an advantage over some other diabetes medications. It also doesn't cause weight gain, and it has benefits for some cardiovascular risk factors. It may even help with weight loss and lowering cholesterol.

  1. Metformin can cause nausea, upset stomach, and diarrhea, particularly when you first start taking it. Typically occur in up to 30% of patients taking metformin.
  2. Over time, metformin may block vitamin B12 absorption in the body. Supplementation of vitamin B12 may be necessary[3]
  3. People with severe kidney impairment or heart failure should not take metformin since in rare cases it can cause lactic acidosis. The risk is very low (around one in 30,000 people taking metformin) but the condition can be fatal.[4][2]

The consumption of certain items which may increase metformin’s side effect profile. Substances include:

  • Alcohol, which increases the risk of lactic acidosis
  • The use of amiloride, digoxin, and morphine, because of their competition for elimination pathways
  • Cimetidine and furosemide which increase metformin’s effect.[5]

Physiotherapy[edit | edit source]

Physiotherapists should encourage patients with diabetes mellitus to discontinue smoking, eat healthily, and participate in regular exercise. Therapists must educate the patient on

  • Monitoring their glucose levels.
  • The need to eat before therapy or physical activity, to avoid hypoglycemia[6].

Anti Ageing Potential[edit | edit source]

In recent years, metformin has attracted growing attention in the field of anti-aging research. Reportedly, numerous studies have indicated that metformin regulates aging-related pathways, possibly delaying the aging process by modulating these pathways. The elucidation of these anti-aging effects may provide insights into the age-retarding[7] potential of metformin.

Back to Pharmacological Management of Diabetes Mellitus[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 Corcoran C, Jacobs TF. Metformin. InStatPearls [Internet] 2021 Jul 19. StatPearls Publishing. Available:https://www.ncbi.nlm.nih.gov/books/NBK518983/ (accessed 9.4.2022)
  2. 2.0 2.1 The Conversation Weekly Dose: metformin, the diabetes drug developed from French lilac Available:https://theconversation.com/weekly-dose-metformin-the-diabetes-drug-developed-from-french-lilac-64430 (accessed25.9.2021)
  3. 3.0 3.1 3.2 3.3 Corcoran C, Jacobs TF. Metformin, in StatPearls. Treasure Island (FL). 2019.Available: https://www.ncbi.nlm.nih.gov/books/NBK518983/ (accessed 25.9.2021)
  4. Very Well Health Metformin Available:https://www.verywellhealth.com/biguanides-diabetes-medications-1087355 (accessed 9.4.2022)
  5. Company, B.-M. S. (n.d.). GLUCOPHAGE. Priceton: Bristol-Myers Squibb Company.
  6. Type 2 diabetes. (2018, September 15). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199      
  7. Hu D, Xie F, Xiao Y, Lu C, Zhong J, Huang D, Chen J, Wei J, Jiang Y, Zhong T. Metformin: A Potential Candidate for Targeting Aging Mechanisms. Aging and disease. 2021 Apr;12(2):480. Available:https://pubmed.ncbi.nlm.nih.gov/33815878/ (accessed25.9.20210