| Role of Metformin in Type 2 Diabetes |
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| Dr Anil Kapur |
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| The ultimate goal of therapy of type 2 diabetes is to normalize glucose metabolism as well as glucose concentrations; and at the same time correct the underlying associated defects. The understanding of the pathogenic mechanisms help us |
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- understand how different therapies work;
- why all therapies are not likely to be as effective in all he different types of patients;
- how to choose the best agent/s in a given patient or situation; and,
- why therapy of type 2 diabetes must evolve over time.
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| The initial therapy of IGT and diabetes is non pharmacological – exercise and nutrition management, logically based on the understanding of the principles outlined above. While this works for IGT and patients presenting early on with type 2 diabetes, for most it is too late to be effective as the only form of treatment and must be supplemented with pharmacological agents as amply demonstrated by the UKPD study. |
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| The ideal initial therapeutic agent/agents should |
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- improve timing and amount of insulin secreted without unduly stressing the already maximally stimulated Beta-cells,
- enhance insulin effect, and
- restore inhibition of hepatic gluconeogenesis to normal depending on the need of each case.
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| Metformin is certainly a popular drug and is used and perhaps misused widely for the treatment of diabetes. The recent publication of the results of the UKPD study have cast a new light on the role of metformin and it is important to review some of the new findings to put into proper perspective the benefits and pitfalls of this very useful drug. |
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| To obtain the best out of any therapy one must know when, where, and how to use it as well as when and where not to use it. This review on metformin is done with the purpose to provide the busy practitioners with precisely this information. |
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