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The Use of Metformin in Type 2 Diabetes Mellitus

The Use of Metformin in Type 2 Diabetes Mellitus

Sample Answer 

The Use of Metformin in Type 2 Diabetes Mellitus

Metformin is a biguanide that is currently indicated for the first-line treatment of type 2 diabetes mellitus. Even though the mechanism of action of metformin is not well-defined, it lowers postprandial and basal plasma glucose levels. Its mechanism of action differs from the other oral antihyperglycemic agents since it reduces the rate of hepatic gluconeogenesis. It has been postulated that the antidiabetic activity of metformin is derived from the fact that it inhibits mitochondrial complex I activity. It also reduces the absorption of glucose in the gastrointestinal tract. To decrease the intestinal absorption of glucose, metformin causes an increase in the anaerobic metabolism of glucose in the intestinal cells. By improving peripheral uptake of glucose and its utilization, metformin increases insulin sensitivity (Rena et al., 2017). All these actions of metformin lead to a reduction in plasma glucose levels hence its use in type 2 diabetes mellitus.

Despite metformin being regarded as a well-tolerated and safe drug, patients taking it for the management of diabetes mellitus should be monitored for its side effects and drug interactions. When used in the long-term management of type 2 diabetes mellitus, it can lead to a decrease in the concentration of vitamin B12 in the blood. Therefore, patients taking metformin especially anemic patients should have their plasma vitamin B12 levels measured periodically. Supplementation of vitamin B12 would be necessary when the plasma levels of vitamin B12 are very low.

Even though lactic acidosis is a rare adverse effect of metformin, it can be fatal when it occurs. The build-up of lactic acid in the body leads to metabolic acidosis. With blood pH being lowered, non-specific signs and symptoms such as abdominal pain, somnolence, respiratory distress, myalgias, and arthralgias occur. Patients also present with elevated levels of lactic acid in the blood (>5 mmol/L). The risk factors for the occurrence of lactic acidosis in patients taking metformin include, alcoholism, hypoxia, surgery, age of more than 65 years, renal impairment, and hepatic impairment (Derbin Vijay et al., 2018). Most of these risk factors either decrease the elimination of lactic acid, or they lower the blood pH.

There are particular drug interactions that predispose patients to lactic acidosis. These drug interactions include the interaction of metformin with topiramate, ranolazine, lamotrigine, iodinated contrast agents, glycopyrrolate, ethanol, dolutegravir, cimetidine, cephalexin, carbonic anhydrase inhibitors, and bupropion (Defronzo et al., 2016). Therefore, patients taking metformin with any of these drugs should be monitored for lactic acidosis. A hypoglycemic effect can also result from the interaction of metformin with other drugs. These drugs include pegvisomant, prothionamide, quinolones, selective serotonin reuptake inhibitors, alpha-lipoic acid, other antidiabetic agents, and androgens. Patients taking metformin with any of these drugs should be monitored for hypoglycemia. They should report any sign or symptom of hypoglycemia. Such signs and symptoms are irritability, confusion, sweating, anxiety, and heart palpitations.

Although metformin is associated with several side effects and drug interactions, several clinical trials have confirmed its safety and efficacy in the management of type 2 diabetes mellitus. A study done on 289 obese individuals with diabetes mellitus confirmed the efficacy of metformin in the management of type 2 diabetes mellitus. In the study, the participants were assigned either a placebo or metformin. Whenever fasting blood glucose exceeded 7.8mmol/L, there was forced titration to 850mg thrice daily from 850mg once daily, and the side effects were well-tolerated. After 29 weeks, it was found that the blood fasting blood glucose was 10.6 mmol/L in patients assigned metformin compared to a mean fasting blood glucose of 13.7 mmol/L in patients given the placebo. When compared with baseline values, there was a decrease in fasting blood glucose by 2.9 mmol/L in the group of patients given metformin. For the placebo group, there was an increase in fasting blood glucose by 0.3 mmol/L. There was also a reduction of mean HbA1c from 8.4% to 7.1%. The mean HbA1c in the placebo group increased from 8.2% to 8.6% (Defronzo & Goodman, 1995). This clinical trial thus confirmed the efficacy of metformin in the management of type 2 diabetes mellitus since there was a reduction in fasting plasma glucose for the patients that were given metformin. Besides, the patients did not show any serious side effects when the dosing interval of metformin was altered to three times daily, confirming the drug’s efficacy.

References

Defronzo, R. A., & Goodman, A. M. (1995). Efficacy of metformin in patients with non-insulin-dependent diabetes mellitus. New England Journal of Medicine, 333(9), 541–549. https://doi.org/10.1056/NEJM199508313330902

Defronzo, R., Fleming, G. A., Chen, K., & Bicsak, T. A. (2016). Metformin-associated lactic acidosis: Current perspectives on causes and risk. Metabolism: Clinical and Experimental, 65(2), 20–29. https://doi.org/10.1016/j.metabol.2015.10.014

Derbin Vijay, V. P., Praveen, D., Ranadheer Chowdary, P., & Vijey Aanandhi, M. (2018). Metformin-induced lactic acidosis: A review. Drug Invention Today, 10(2), 216–218.

Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of metformin. Diabetologia, 60(9), 1577–1585. https://doi.org/10.1007/s00125-017-4342-z

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Question 


The Use of Metformin in Type 2 Diabetes Mellitus

Select a medication using the treatment guidelines for osteoporosis, thyroid disorder, or diabetes mellitus.

The Use of Metformin in Type 2 Diabetes Mellitus

The Use of Metformin in Type 2 Diabetes Mellitus

Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including interactions with CAM.
In addition, share a clinical trial that supports the use of this agent. Include the name of the medication in the subject line so that the medications can be followed. Include references using APA format.

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