Metformin is a commonly used oral hypoglycemic agent primarily prescribed for the treatment of Type 2 diabetes mellitus. It works by reducing hepatic glucose production and enhancing insulin sensitivity in muscle and adipose tissues, thereby effectively lowering blood glucose levels. This medication is also used in the treatment of polycystic ovary syndrome (PCOS), improving ovulatory function and metabolic abnormalities.
Since its introduction in the 1950s, metformin has become one of the most preferred drugs worldwide for diabetes management due to its low cost, clear efficacy, and relatively manageable side effects. Recent studies suggest it may have cardiovascular protective effects and potentially reduce the risk of cancer in diabetic patients, leading to its widespread clinical application.
Metformin belongs to the class of "biguanides" oral hypoglycemic agents. Its mechanism of action differs from sulfonylureas or DPP-4 inhibitors, as it does not stimulate pancreatic insulin secretion, thus posing a lower risk of hypoglycemia. It is typically used as a first-line treatment for Type 2 diabetes and can be combined with other hypoglycemic agents or insulin.
In drug classification, it also exhibits properties that improve metabolic abnormalities, which is why it is included in treatment guidelines for PCOS to regulate hormonal imbalances and promote ovulation. Its unique molecular structure allows it to reduce hepatic glycogenolysis without causing weight gain as a side effect.
Primarily used to control blood glucose in patients with Type 2 diabetes, usually when diet and exercise are insufficient. The medication can be used alone or in combination with other oral hypoglycemic agents (such as SGLT-2 inhibitors) or insulin to achieve better glycemic control.
According to medical guidelines, metformin is also approved for treating PCOS, especially in patients with insulin resistance leading to hyperandrogenism or ovulatory dysfunction. Some studies suggest it may have adjunct benefits for metabolic abnormalities in Type 1 diabetes patients, but use should be evaluated by a physician.
Contraindications and High-Risk Groups:
Pregnancy and Lactation:
Special caution is required when used concomitantly with the following medications:
Interactions with alcohol:
Initial doses are usually 500-1000 mg per day, taken once or twice, with meals or immediately after eating to reduce gastrointestinal irritation. Dosages are gradually increased based on blood glucose control, with a target dose of 1500-2000 mg daily, adjusted according to renal function.
Extended-release formulations should be swallowed whole and not chewed to prolong absorption and reduce gastrointestinal discomfort. When treating Type 2 diabetes, if eGFR is below 45 mL/min/1.73m², dose reduction or discontinuation is necessary.
If a dose is missed and more than 2 hours remain before the next scheduled dose, take the missed dose immediately and continue with the next dose at the regular time. If close to the scheduled time, skip the missed dose—do not double up to make up for it, as this may increase the risk of hypoglycemia or side effects.
Set medication reminders and take at consistent times to maintain stable drug levels. If doses are frequently missed, consult a healthcare provider to consider adjusting the treatment plan.
Overdose can lead to severe symptoms including nausea, vomiting, rapid and deep breathing (metabolic acidosis), and altered mental status. Suspected overdose requires immediate medical attention, possibly including gastric lavage or dialysis.
Home emergency measures:
What precautions should be taken when combining metformin with insulin or other hypoglycemic agents?
Combining metformin with insulin or sulfonylureas may increase the risk of hypoglycemia. Physicians usually adjust dosages and recommend regular blood glucose monitoring. Symptoms such as sweating, trembling, or dizziness should prompt immediate intake of sugary foods and contacting healthcare providers. Regular monitoring of liver and kidney function is essential to ensure proper drug metabolism.
Should I stop taking metformin if I experience gastrointestinal discomfort?
Gastrointestinal side effects like diarrhea and nausea are common early reactions and often resolve within a few weeks. Starting with a low dose and gradually increasing to the target dose, taken with meals, can help reduce discomfort. If symptoms are severe or persist beyond two weeks, consult a healthcare provider for possible dose adjustment; do not stop medication abruptly without medical advice, as it may affect blood glucose control.
Are there special considerations for patients on imaging tests such as CT scans?
Some imaging procedures require iodinated contrast agents, which can affect renal function. In such cases, the physician may advise temporarily discontinuing metformin and reassessing when to resume therapy after the procedure. Patients should inform medical staff beforehand about their metformin use to prevent potential risks.
Does long-term use of metformin lead to vitamin B12 deficiency?
Prolonged use may slightly impair vitamin B12 absorption, but clinically significant deficiency is rare. Regular blood tests are recommended, and if deficiency is diagnosed, supplementation can be done as advised. Generally, patients do not need to worry excessively, but vegetarians or those with absorption issues should monitor related indicators more closely.
Is metformin suitable for overweight or obese patients with Type 2 diabetes?
Metformin is one of the first-choice treatments for overweight or obese patients with Type 2 diabetes, as it not only lowers blood glucose but may also have a mild weight-reducing effect. Patients should combine medication with dietary control and regular exercise to enhance efficacy. For severe weight issues, physicians may recommend additional weight-loss medications or interventions.
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