Metformin

Nonglycemic effects and potential novel indications

Abeer Anabtawi, John M. Miles

Research output: Contribution to journalReview article

26 Citations (Scopus)

Abstract

Objective: Metformin is the most commonly prescribed drug for the treatment of type 2 diabetes because of its apparent robust effects in reducing cardiovascular risk. This review examines the current literature regarding the nonglycemic effects and potential novel indications for metformin. Methods: Review of the literature, with a focus on metformin use in Stage 3 chronic kidney disease (CKD-3) and heart failure (HF). Results: The United Kingdom Prospective Diabetes Study suggests that metformin reduces the risk of myocardial infarction, and more recent retrospective studies have shown an association between metformin use and a reduction in stroke, atrial fibrillation and all-cause mortality. The mechanism(s) explaining these putative benefits are not clear but may involve decreased energy intake (with attendant weight loss), improvement in lipids, and lowering of blood pressure; a literature review suggests that metformin lowers blood pressure when it is elevated, but not when it is normal. Metformin appears to be safe when given to patients with CKD-3. In addition, there is evidence that individuals with CKD-3, who are at increased cardiovascular risk, stand to benefit from metformin therapy. Lactic acidosis is an extremely remote and probably avoidable risk; measurement of plasma metformin levels and more frequent monitoring of renal function may be useful in selected patients with CKD-3 who are treated with metformin. Finally, there is evidence that metformin is safe in patients with HF; metformin therapy is associated with a reduction in newly incident HF and in HF mortality. Conclusion: Metformin has a dominant position in the treatment of type 2 diabetes that is deserved due to its favorable and robust effects on cardiovascular risk.

Original languageEnglish (US)
Pages (from-to)999-1007
Number of pages9
JournalEndocrine Practice
Volume22
Issue number8
DOIs
StatePublished - Aug 1 2016
Externally publishedYes

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Metformin
Heart Failure
Type 2 Diabetes Mellitus
Blood Pressure
Lactic Acidosis
Mortality
Therapeutics
Energy Intake
Chronic Renal Insufficiency
Atrial Fibrillation
Weight Loss
Retrospective Studies
Stroke
Myocardial Infarction

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Metformin : Nonglycemic effects and potential novel indications. / Anabtawi, Abeer; Miles, John M.

In: Endocrine Practice, Vol. 22, No. 8, 01.08.2016, p. 999-1007.

Research output: Contribution to journalReview article

Anabtawi, Abeer ; Miles, John M. / Metformin : Nonglycemic effects and potential novel indications. In: Endocrine Practice. 2016 ; Vol. 22, No. 8. pp. 999-1007.
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