Metformin: The Gold Standard Antidiabetic Drug

In India, chronic diseases such as diabetes mellitus (DM) is one of the leading cause of morbidity and affects the quality of life of millions of people die every year, due to lack of awareness regarding the management of diabetes and their treatments. In fact, India is known as the ‘Diabetes Capital of the World’.
Diabetes management includes:
– Lifestyle modifications- Dietary modifications, regular exercises and quitting alcohol or smoking
– Pharmacological Treatment- Use of anti-diabetic drugs and Insulin Injections

Lifestyle modifications are essential for the management of diabetes, but here we present one of the anti-diabetic drugs which have been a pioneer in the management of DM.
Metformin is the first line anti-diabetic drug for the management of diabetes.
Before knowing more about the drug first let us enlighten you about DM. Then we’ll talk about the “gold standard anti-diabetic drug” for the management of diabetes.
So let’s get started;
What is diabetes mellitus?
Diabetes is a metabolic disorder generally caused due to increased blood glucose or blood sugar level. The body gets glucose from the food that we eat, and it is required for energy and proper functioning of other organs.

Insulin is a hormone secreted from beta cells of the pancreas regulate the uptake of glucose via cells. The improper functioning of insulin is the root cause of diabetes. It is broadly classified into two types-

1. Type 1 diabetes: in this type, the body unable to produce insulin
2. Type 2 diabetes: in this type, the body produces less insulin or may not be able to use insulin properly due to obesity (insulin resistance). It is the most common type of diabetes.

Anti-diabetic drugs are extensively used for the management of DM. One of the classes of anti-diabetic drugs is Biguanides.

Biguanides
– These are derived from guanylguanidine and are the widely prescribed anti-diabetic drugs for the management of type 2 diabetes. Biguanides act mainly by preventing glucose production in the liver and also improves body sensitivity towards insulin.
– The most preferred biguanides are metformin.

Metformin
– Metformin is an insulin sensitizer a gold standard oral anti-diabetic drug for the management of type 2 diabetes mellitus.
– It neither increases the concentration of glucose in the blood, nor it causes severe hypoglycemia; hence, metformin is regarded as the ‘antihyperglycemic agent’ whereas other antidiabetic drugs such as sulfonylureas and meglitinides are hypoglycemic agents.

How does Metformin work?
i) Metformin show antihyperglycemic activity mainly by reducing the production of glucose in the liver by inhibiting gluconeogenesis (a metabolic pathway for the generation of glucose from protein and lipid) and glycogenolysis (a process of breakdown of glycogen into glucose).
– Slows down the absorption of glucose via the intestine
– Enhances the peripheral uptake of glucose by increasing insulin sensitivity.
– Reduce the level of low-density lipid (bad cholesterol) and triglycerides.

ii)Metformin can be used either as monotherapy or in combination with some other oral hypoglycemic agents.

Side effects related to metformin
– Along with the beneficial effects every drug has certain side effects, so does the metformin has. But it has been approved by USFDA and regarded has been regarded as a safe and well tolerated anti-diabetic drug.
– The most common side effects associated with metformin are diarrhoea, flatulence, abdominal discomfort, nausea, and metallic taste.
– These side effects are dose-related and can be minimized by reducing the dose or an extended release formulation.

Advantages:
– No risk of lactic acidosis: Unlike other biguanides, metformin is not associated with the risk of lactic acidosis.
– Rare risk of hypoglycemia: Hypoglycemia is decreased blood glucose level; the metformin does not cause hypoglycemia.
– No Weight gain: Like other hypoglycemic agents such as sulfonylureas and meglitinide, the metformin does not increase the weight; hence, it is a safe anti-diabetic drug for an obese patient having diabetes.
– Decreases LDL levels: Long term therapy with metformin decreases the level of LDL (low-density lipid), cholesterol and triglycerides.

Concluding, metformin is a safe drug with numerous therapeutic benefits. That is why it is considered the “gold standard anti-diabetic drug”.

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