Metformin for Type 2 Diabetes.

Abstract

Metformin for Type 2 Diabetes To the Editor Drs Flory and Lipska1 reviewed the literature on metformin, analyzing several aspects such as its mechanism of action, clinical use, and safety. The efficacy of metformin has also been investigated in other studies, comparing it with other drugs already in use. In the short and medium term, metformin has shown an efficacy comparable with sulfonylureas, without exposing the patient to hypoglycemic risk, and to acarbose and pioglitazone, and with efficacy higher than dipeptidyl peptidase 4 (DPP-4) inhibitors but lower than glucagon-like peptide 1 (GLP-1) receptor agonists. In long-term monotherapy, metformin shows an increased efficacy compared with sulfonylureas.2 In addition, in patients with type 2 diabetes aged 10 to 16 years, several randomized studies have shown an efficacy and tolerability of metformin similar to that in adults.3 In elderly individuals, because of renal function impairment, patients may become ineligible for metformin.2 In these patients, the risk of developing metformin-induced lactic acidosis increases. However, the incidence of this adverse event has decreased over time, thanks to an education campaign by specialists on the proper use of metformin in patients at risk, with a decrease in incidence from 76.8 cases per 100 000 in 2010 to 32.9 cases per 100 000 in 2014.4 The use of metformin in elderly men with type 2 diabetes showed a reduced risk of all-cause mortality and age-related comorbidities such as cardiovascular diseases, neoplasms, dementia, depression, and frailty.5