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Metformin

First-line oral medication for type 2 diabetes.

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For individuals who are overweight, metformin serves as the primary initial oral therapy for managing type 2 diabetes.[1] The medication is additionally prescribed for polyendocrine metabolic ovarian syndrome and, outside of its approved indications, to help lower metabolic syndrome risks associated with antipsychotic drug use.[1] Diarrhea, nausea, and abdominal pain are frequent adverse effects, though the drug is usually well-tolerated.[2]

Key facts and history

The American Diabetes Association and the American College of Physicians recommend metformin as a first-line agent for type 2 diabetes.[3] Emil Werner and James Bell provided the initial scientific description of metformin in 1922.[4] Human testing was initiated by the French doctor Jean Sterne during the 1950s, and he introduced it as a therapeutic agent in France in 1957.[4] With over 85 million prescriptions written in 2023, metformin ranked as the second most frequently prescribed medication in the United States.[4]

Metformin's mechanisms include reducing hepatic glucose output, improving insulin sensitivity, and promoting GDF15 secretion, which curbs appetite.[5] The probability of experiencing low blood sugar with metformin is small.[2] Elevated blood lactic acid becomes a risk when excessively high doses are taken or in patients with severe renal impairment.[2]

What the cited sources add

The DailyMed prescribing information states that metformin-associated lactic acidosis has resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias.[6] The same source notes that risk factors include renal impairment, age over 65, and excessive alcohol intake.[6] The NHS also reports that metformin can cause serious side effects including lactic acidosis and anaphylaxis.[7] The DailyMed source indicates that metformin is present in human milk at infant doses of 0.11% to 1% of the maternal weight-adjusted dosage.[6]

Type 2 diabetes, gestational diabetes, and polyendocrine metabolic ovarian syndrome are conditions that metformin is indicated to treat, according to the UK's National Health Service.[7]

References

  1. Wikipedia, "Metformin" (CC BY-SA 4.0), which cites: "9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2022", Diabetes Care, January 2022, p. S125–S143; "2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD", European Heart Journal, January 2020, p. 255–323; "Metformin Hydrochloride", The American Society of Health-System Pharmacists; "Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis", Annals of Internal Medic en.wikipedia.org
  2. Wikipedia, "Metformin" (CC BY-SA 4.0), which cites: "Metformin is not just an antihyperglycaemic drug but also has protective effects on the vascular endothelium", Acta Physiologica, January 2017, p. 138–151; "Metformin Hydrochloride", The American Society of Health-System Pharmacists; "Metformin Hydrochloride", The American Society of Health-System Pharmacists; "Do Patients Die with or from Metformin-Associated Lactic Acidosis (MALA)? Systematic Review and Meta-analysis of pH and Lactate as Predictors of Mortality in MALA", Journal of Medical Toxicology, April 2020, p. 222–229; "Use of metfor en.wikipedia.org
  3. Wikipedia, "Metformin" (CC BY-SA 4.0), which cites: "Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations", Annals of Internal Medicine, May 2011, p. 602–13; "Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)", Diabetes Care, J; "Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians", Annals of Inter en.wikipedia.org
  4. Wikipedia, "Metformin" (CC BY-SA 4.0), which cites: "Analogue-based Drug Discovery II", John Wiley & Sons, 2010, p. 49; "Analogue-based Drug Discovery II", John Wiley & Sons, 2010, p. 49; "Metformin Hydrochloride", The American Society of Health-System Pharmacists; "Herb, nutrient, and drug interactions: clinical implications and therapeutic strategies", Mosby/Elsevier, 2008, p. 217; "The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023)", World Health Organization, 2023; "Metformin Hydrochloride", The Amer en.wikipedia.org
  5. Wikipedia, "Metformin" (CC BY-SA 4.0), which cites: "Metformin Hydrochloride", The American Society of Health-System Pharmacists; "Metformin Hydrochloride", The American Society of Health-System Pharmacists; "GDF15 mediates the effects of metformin on body weight and energy balance", Nature, February 2020, p. 444–448; "Metformin-induced increases in GDF15 are important for suppressing appetite and promoting weight loss", Nature Metabolism, December 2019, p. 1202–1208; "Medical Management of Diabesity: Do We Have Realistic Targets?", Current Diabetes Reports, January 2017; "Metformin, phenformi en.wikipedia.org
  6. "Glucophage (metformin hydrochloride) tablets, for oral use; Glucophage XR (metformin hydrochloride) extended-release tablets, for oral use Initial U.S. Approval:1995", DailyMed. facts only, no text reused. dailymed.nlm.nih.gov
  7. "Metformin: medicine to treat type 2 diabetes", National Health Service, 25 February 2019. facts only, no text reused. nhs.uk

Each numbered sentence above was checked against the source it cites before publication. Sentences citing Wikipedia adapt text from the English Wikipedia article Metformin (contributors), used under CC BY-SA 4.0; this entry is available under the same licence. Other sources were used for facts only; no text or images are copied from them.

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Sources

Compiled from Wikipedia and the sources listed below. Text from Wikipedia is available under CC BY-SA 4.0; this entry is adapted from it.

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