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Latest & greatest articles for metformin
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Metformin: an update. Metformin is an insulin-sensitizing agent with potent antihyperglycemic properties. Its efficacy in reducing hyperglycemia in type 2 diabetes mellitus is similar to that of sulfonylureas, thiazolidinediones, and insulin. Metformin-based combination therapy is often superior to therapy with a single hypoglycemic agent. The antihyperglycemic properties of metformin are mainly attributed to suppressed hepatic glucose production, especially hepatic gluconeogenesis (...) , and increased peripheral tissue insulin sensitivity. Although the precise mechanism of hypoglycemic action of metformin remains unclear, it probably interrupts mitochondrial oxidative processes in the liver and corrects abnormalities of intracellular calcium metabolism in insulin-sensitive tissues (liver, skeletal muscle, and adipocytes) and cardiovascular tissue.
Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Metformin is an oral anti-hyperglycemic agent used in the treatment of type 2 diabetes mellitus. The results of the UK Prospective Diabetes Study indicate that metformin treatment is associated with a reduction in total mortality compared to other anti-hyperglycemic treatments. Metformin, however, is thought to increase the risk of lactic acidosis, and is considered to be contraindicated in many chronic (...) hypoxemic conditions that may be associated with lactic acidosis, such as cardiovascular, renal, hepatic and pulmonary disease, and advancing age.To assess the incidence of fatal and nonfatal lactic acidosis with metformin use compared to placebo and other glucose-lowering treatments in patients with type 2 diabetes mellitus. A secondary objective was to evaluate the blood lactate levels for those on metformin treatment compared to placebo or non-metformin therapies.A search was performed
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay (...) the development of diabetes.We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45
Health and economic effects of adding nateglinide to metformin to achieve dual control of glycosylated hemoglobin and postprandial glucose levels in a model of Type 2 diabetes mellitus Health and economic effects of adding nateglinide to metformin to achieve dual control of glycosylated hemoglobin and postprandial glucose levels in a model of Type 2 diabetes mellitus Health and economic effects of adding nateglinide to metformin to achieve dual control of glycosylated hemoglobin (...) and postprandial glucose levels in a model of Type 2 diabetes mellitus Salas M, Ward A, Caro J Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Combination therapy with nateglinide and metformin was compared with metformin monotherapy
Metformin associated lactic acidosis following administration of intravenous contrast media Metformin associated lactic acidosis following administration of intravenous contrast media Metformin associated lactic acidosis following administration of intravenous contrast media Jackson N Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation Jackson N. Metformin (...) associated lactic acidosis following administration of intravenous contrast media. Centre for Clinical Effectiveness (CCE). Evidence Centre Evidence Report. 2002 Authors' objectives This aim of this report was to assess the risk associated with contrast agents and patients on Metformin. Authors' conclusions - Findings from a systematic review and a case series have shown that Metformin related lactic acidosis occurs mainly in patients with abnormal renal function. For this reason the authors agree
Metformin in non-alcoholic steatohepatitis. There is no established treatment for steatohepatitis in patients who are not alcoholics. This disease is a potentially progressive liver disease associated with hepatic insulin resistance. Only a weight-reducing diet in overweight patients has proved effective. We treated 20 patients who had steatohepatitis but were not alcoholics with metformin (500 mg three times a day for 4 months), an agent that improves hepatic insulin sensitivity. When compared (...) with the six individuals not complying with treatment, long-term metformin significantly reduced mean transaminase concentrations, which returned to normal in 50% of actively-treated patients. Also, insulin sensitivity improved significantly and liver volume decreased by 20%. Similar data have been reported in insulin-resistant ob/ob mice with fatty liver. A randomised-controlled study is needed.
Lactic acidosis in metformin therapy: searching for a link with metformin in reports of 'metformin-associated lactic acidosis' Lactic acidosis in metformin therapy: searching for a link with metformin in reports of 'metformin-associated lactic acidosis' Lactic acidosis in metformin therapy: searching for a link with metformin in reports of 'metformin-associated lactic acidosis' Lalau J D, Race J M Authors' objectives To review all reports of lactic acidosis in metformin-treated patients (...) published since May 1995, to try to establish the link between metformin and the onset of lactic acidosis. Searching BIOSIS Previews, MEDLINE, EMBASE, Pascal and a Derwent database were searched for literature published in any language from May 1995 to January 2000. The search terms were not reported. Study selection Study designs of evaluations included in the review The authors seem to have searched for single case reports and case series. Specific interventions included in the review Metformin
Cost-effectiveness analysis of intensive blood-glucose control with metformin in overweight patients with Type II diabetes (UKPDS No 51) Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Metformin in the treatment of HIV lipodystrophy syndrome: A randomized controlled trial. A syndrome of lipodystrophy, characterized by fat redistribution and insulin resistance, has been estimated to affect the majority of human immunodeficiency virus (HIV)-infected individuals who are treated with combination antiretroviral therapy. There are no proven therapies for the metabolic disturbances associated with HIV lipodystrophy syndrome.To determine the safety and efficacy of metformin therapy (...) in HIV-infected patients with fat redistribution and abnormal glucose homeostasis.Randomized, double-blind, placebo-controlled pilot study conducted in a university hospital between December 1998 and January 2000.Twenty-six HIV-infected, nondiabetic patients with fat redistribution and abnormal oral glucose tolerance test (OGTT) results, hyperinsulinemia, or both.Patients were randomly assigned to receive metformin, 500 mg twice daily (n = 14), or identical placebo (n = 12), for 3 months.Insulin area
Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: a randomized controlled trial. Most antidiabetic agents target only 1 of several underlying causes of diabetes. The complementary actions of the antidiabetic agents metformin hydrochloride and rosiglitazone maleate may maintain optimal glycemic control in patients with type 2 diabetes; therefore, their combined use may be indicated for patients whose diabetes is poorly controlled by metformin (...) alone.To evaluate the efficacy of metformin-rosiglitazone therapy in patients whose type 2 diabetes is inadequately controlled with metformin alone.Randomized, double-blind, placebo-controlled trial from April 1997 and March 1998.Thirty-six outpatient centers in the United States.Three hundred forty-eight patients aged 40 to 80 years with a mean fasting plasma glucose level of 12.0 mmol/L (216 mg/dL), a mean glycosylated hemoglobin level of 8.8%, and a mean body mass index of 30.1 kg/m2 were
Applying some UK Prospective Diabetes Study results to Switzerland: the cost-effectiveness of intensive glycaemic control with metformin versus conventional control in overweight patients with type-2 diabetes Applying some UK Prospective Diabetes Study results to Switzerland: the cost-effectiveness of intensive glycaemic control with metformin versus conventional control in overweight patients with type-2 diabetes Applying some UK Prospective Diabetes Study results to Switzerland: the cost (...) -effectiveness of intensive glycaemic control with metformin versus conventional control in overweight patients with type-2 diabetes Palmer A J, Sendi P P, Spinas G A Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of metformin
Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. Treatment with diet alone, insulin, sulfonylurea, or metformin is known to improve glycemia in patients with type 2 diabetes mellitus, but which treatment most frequently attains target fasting plasma glucose (FPG) concentration of less than 7.8 mmol/L (140 mg/dL) or glycosylated (...) years following diagnosis.The proportion of patients who maintained target glycemic levels declined markedly over 9 years of follow-up. After 9 years of monotherapy with diet, insulin, or sulfonylurea, 8%, 42%, and 24%, respectively, achieved FPG levels of less than 7.8 mmol/L (140 mg/dL) and 9%, 28%, and 24% achieved HbA1c levels below 7%. In obese patients randomized to metformin, 18% attained FPG levels of less than 7.8 mmol/L (140 mg/dL) and 13% attained HbA1c levels below 7%. Patients less
Efficacy of metformin in the treatment of NIDDM: meta-analysis Efficacy of metformin in the treatment of NIDDM: meta-analysis Efficacy of metformin in the treatment of NIDDM: meta-analysis Johansen K Authors' objectives To conduct a meta-analysis of the efficacy of metformin in the treatment of non-insulin dependent diabetes mellitus, by comparing metformin with placebo and sulfonylurea. Searching The Current List of Medical Literature was searched from 1957 to 1959, the Cumulated Index Medicus (...) was searched from 1959 to 1965, and MEDLINE and EMBASE were searched from inception to January 1996. The search terms used were 'metformin', 'phenformin' and 'humans'. Reference lists of all relevant articles were scanned. Study selection Study designs of evaluations included in the review Included studies had to be full publications of randomised controlled trials (RCTs). RCTs could be blind or open, parallel or crossover. Specific interventions included in the review The included studies compared
Efficacy and metabolic effects of metformin and troglitazone in type II diabetes mellitus. Combination therapy is logical for patients with non-insulin-dependent (type 2) diabetes mellitus, because they often have poor responses to single-drug therapy. We studied the efficacy and physiologic effects of metformin and troglitazone alone and in combination in patients with type 2 diabetes.We randomly assigned 29 patients to receive either metformin or troglitazone for three months, after which (...) they were given both drugs for another three months. Plasma glucose concentrations during fasting and postprandially and glycosylated hemoglobin values were measured periodically during both treatments. Endogenous glucose production and peripheral glucose disposal were measured at base line and after three and six months.During metformin therapy, fasting and postprandial plasma glucose concentrations decreased by 20 percent (58 mg per deciliter [3.2 mmol per liter], P<0.001) and 25 percent (87 mg per
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. In patients with type 2 diabetes, intensive blood-glucose control with insulin or sulphonylurea therapy decreases progression of microvascular disease and may also reduce the risk of heart attacks. This study investigated whether intensive glucose control with metformin has any specific advantage or disadvantage.Of 4075 (...) patients recruited to UKPDS in 15 centres, 1704 overweight (>120% ideal bodyweight) patients with newly diagnosed type 2 diabetes, mean age 53 years, had raised fasting plasma glucose (FPG; 6.1-15.0 mmol/L) without hyperglycaemic symptoms after 3 months' initial diet. 753 were included in a randomised controlled trial, median duration 10.7 years, of conventional policy, primarily with diet alone (n=411) versus intensive blood-glucose control policy with metformin, aiming for FPG below 6 mmol/L (n=342
Metformin: an antihyperglycemic agent for treatment of type II diabetes Metformin: an antihyperglycemic agent for treatment of type II diabetes Metformin: an antihyperglycemic agent for treatment of type II diabetes Melchior W R, Jaber L A Authors' objectives To review the comparative efficacy of metformin, sulfonylureas, and insulin in the treatment of patients with type II diabetes. Searching MEDLINE was searched from 1966 to 1994 for articles published in English, French or German, using (...) the search terms 'metformin', 'sulfonylurea', 'chlorpropamide', 'glipzide', 'glyburide', 'tolazamide', 'tolbutamide' and 'insulin'. Bibliographies of pertinent articles were also examined for relevant studies. Study selection Study designs of evaluations included in the review Randomised active, controlled studies were included. Specific interventions included in the review Metformin, chlorpropamide, glyburide, tolbutamide, insulin and diet therapy. Participants included in the review Patients with type
Efficacy of metformin in patients with non-insulin-dependent diabetes mellitus. The Multicenter Metformin Study Group. Sulfonylurea drugs have been the only oral therapy available for patients with non-insulin-dependent diabetes mellitus (NIDDM) in the United States. Recently, however, metformin has been approved for the treatment of NIDDM.We performed two large, randomized, parallel-group, double-blind, controlled studies in which metformin or another treatment was given for 29 weeks (...) to moderately obese patients with NIDDM whose diabetes was inadequately controlled by diet (protocol 1: metformin vs. placebo; 289 patients), or diet plus glyburide (protocol 2: metformin and glyburide vs. metformin vs. glyburide; 632 patients). To determine efficacy we measured plasma glucose (while the patients were fasting and after the oral administration of glucose), lactate, lipids, insulin, and glycosylated hemoglobin before, during, and at the end of the study.In protocol 1, at the end of the study
United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. To assess the relative efficacy of treatments for non-insulin dependent diabetes over three years from diagnosis.Multicentre, randomised, controlled trial allocating patients to treatment with diet alone or additional chlorpropamide, glibenclamide, insulin, or metformin (...) ). In obese subjects metformin was as effective as the other drugs with no change in mean body weight and significant reduction in mean fasting plasma insulin concentration (-2.5 mU/l; P < 0.001). More hypoglycaemic episodes occurred with sulphonylurea or insulin than with diet or metformin.The drugs had similar glucose lowering efficacy, although most patients remained hyperglycaemic. Long term follow up is required to determine the risk-benefit ratio of the glycaemic improvement, side effects, changes
Worldwide experience of metformin as an effective glucose-lowering agent: a meta-analysis Worldwide experience of metformin as an effective glucose-lowering agent: a meta-analysis Worldwide experience of metformin as an effective glucose-lowering agent: a meta-analysis Campbell I W, Howlett H C Authors' objectives To assess the efficacy of metformin compared to sulphonylurea(s) as a first-line treatment of non-insulin dependent diabetes mellitus, when diet alone has failed to control blood (...) glucose. Searching MEDLINE, EMBASE, Pascal and BIOSIS Previews were searched from January 1957 to September 1994 in all languages with the keywords terms: 'metformin', 'sulphonylureas' and 'humans'. Major diabetic and endocrinology textbooks and review articles were also studied. Study selection Study designs of evaluations included in the review Published randomised controlled trials (RCTs). Crossover or non-crossover, open or blinded with a minimum duration of treatment of 6 weeks. Specific