Metformin

Lore & Background

Metformin works by decreasing glucose production in the liver, increasing the insulin sensitivity of body tissues, and increasing GDF15 secretion, which reduces appetite and caloric intake. It has been shown to inhibit inflammation and is not associated with weight gain. Common adverse effects include diarrhea, nausea, and abdominal pain. It has a small risk of causing low blood sugar. High blood lactic acid level (acidosis) is a concern if the medication is used in overly large doses or prescribed to people with severe kidney problems.

Reader's Guide

Metformin is significant as the primary first-line medication for type 2 diabetes, recommended by the American Diabetes Association and the American College of Physicians. It is as effective as repaglinide and more effective than all other oral drugs for type 2 diabetes. Its use extends to polyendocrine metabolic ovarian syndrome, where tentative evidence shows it increases the rate of live births, and as an off-label adjunct to reduce metabolic syndrome risk in people taking antipsychotic medication. Metformin is associated with weight loss in obesity in the absence of diabetes and modestly reduces low density lipoprotein and triglyceride levels. In prediabetes, moderate-quality evidence shows it reduces the risk of developing type 2 diabetes compared to diet and exercise or placebo, but not when compared to intensive diet or exercise alone.

Did You Know?

• Metformin is on the World Health Organization's List of Essential Medicines.