Biguanides: Metformin Overview

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Questions and Answers

What is the main mechanism by which Metformin helps manage type 2 diabetes?

  • Increases pancreatic insulin secretion
  • Increases glucose absorption in the intestines
  • Decreases hepatic glucose production (correct)
  • Inhibits insulin resistance in the liver

What is the recommended initial dosage of Metformin for adults?

  • 250 mg
  • 500 mg (correct)
  • 1000 mg
  • 750 mg

Which of the following side effects is most commonly associated with Metformin?

  • Metallic taste (correct)
  • Hypertension
  • Hypoglycemia
  • Weight gain

What percentage reduction in A1C levels can Metformin achieve in drug-naïve patients?

<p>1.5%–2% (D)</p> Signup and view all the answers

Why is Metformin considered a first-line therapy for type 2 diabetes?

<p>It is effective and has low risk of side effects (B)</p> Signup and view all the answers

Flashcards

Metformin

A medication used to manage type 2 diabetes. It works by decreasing glucose production in the liver, increasing insulin sensitivity in muscles, and promoting glucose uptake into muscles.

Gastrointestinal (GI) side effects

A common side effect of metformin, often occurring at the start of treatment. It typically resolves over time as your body adjusts to the medication.

Contraindication in renal insufficiency

Metformin should not be used in patients with severely impaired kidney function.

Metformin and HDL cholesterol

Metformin can modestly increase 'good' cholesterol (HDL-C) levels, which is beneficial for heart health.

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Initiation and titration of Metformin

Metformin is typically initiated at a low dose and gradually increased over several weeks to minimize side effects and allow the body to adjust.

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Study Notes

Biguanides: Metformin

  • Oral medication for type 2 diabetes
  • Action:
    • Lowers hepatic glucose production
    • Increases insulin sensitivity in muscle tissues, allowing for increased glucose uptake
  • First-line treatment for type 2 diabetes (unless contraindicated or intolerable)
  • Initiating therapy:
    • Start with a low dose (500 mg) with the largest meal
    • Increase dose gradually (500 mg increments) over several weeks
  • Advantages:
    • Reduces A1C levels by 1.5%–2%
    • Reduces fasting plasma glucose (FPG) levels by 60–80 mg/dL in patients with initially high A1C
    • Lowers triglycerides (TG) and LDL-C by ~8%–15%
    • May modestly increase HDL-C by 2%
    • Does not cause weight gain; may lead to modest weight loss (2–3 kg)
    • Low risk of hypoglycemia as it doesn't directly stimulate insulin secretion
  • Adverse effects:
    • Frequent gastrointestinal (GI) side effects (diarrhea, abdominal discomfort, upset stomach)
    • Dose-dependent, usually transient, and mild
    • Minimized by slow dose titration and taking with meals
    • Extended-release metformin may slightly lessen GI effects; no significant difference compared to immediate-release regarding GI side effects.
    • Metallic taste
    • May lower vitamin B12 levels (annual B12 measurements recommended)
  • Contraindications:
    • Renal insufficiency (eGFR) - Metformin is excreted by the kidneys and builds up in kidney problems.

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