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It lowers hemoglobin AIc concentrations by 1.0% to 1.5%.
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When metformin is used as monotherapy, hypoglycemia is a serious side effect.
It has been shown to for 1 last update 30 May 2020 reduce all-cause mortality.It has been shown to reduce all-cause mortality.
Source: Cheng AY, Fantus IG. Oral antihyperglycemic therapy for type 2 diabetes mellitus. CMAJ 2005;172:213-26.
This question is based on Question 32, Metformin and type 2 diabetes mellitus. Self Learning 2005;20(4):38-9. Published 6 times yearly, each issue of Self Learning contains a blend of questions from a range of peer-reviewed medical journals. College of Family Physicians of Canada members who subscribe to the Self Learning program may claim up to 5 Mainpro-M1 credits for each completed issue and up to 30 Mainpro-M1 credits for each year in which they subscribe. For further information please visit the College of Family Physicians of Canada website, which includes information on free trials of the on-line program, at http://www.cfpc.ca/sli.
Metformin lowers blood glucose among patients with type 2 diabetes mellitus largely by decreasing hepatic glucose output. It is also thought to increase glucose uptake by skeletal muscle. It is not protein bound and has maximum accumulation in the small intestine wall. It is excreted unmodified by the kidney.
In placebo-controlled trials, metformin lowered hemoglobin AIc concentrations by 1.0% to 1.5%. The efficacy of metformin monotherapy is equivalent to that of sulfonylurea monotherapy. It is associated with weight loss or at least no weight gain. Improvements in lipid profiles have also been noted. The United Kingdom Prospective Diabetes Study examined the long-term effects of metformin compared with conventional diet therapy and intensive sulfonylurea or insulin therapy in a subgroup of overweight patients. The metformin group experienced less hypoglycemia and weight gain than did the intensive groups. In addition, the metformin group experienced a 36% relative risk reduction in all-cause mortality, a 39% relative risk reduction in myocardial infarction, and a 30% relative risk reduction in all macrovascular end points compared with the conventional group.
Gastrointestinal side effects of metformin are observed in 10% to 15% of patients, depending on the dose, and include abdominal discomfort, anorexia, bloating, and diarrhea. Because insulin secretion is unaltered, hypoglycemia is not a side effect of metformin used as monotherapy.
To date, metformin is the only oral hypoglycemic agent to demonstrate substantial cardiovascular benefit over and above its glucose-lowering effect in diabetes. It is recommended as first-line therapy for overweight patients with type 2 diabetes mellitus.
This is not the right answer. In placebo-controlled trials, metformin lowered hemoglobin AIc concentrations by 1.0% to 1.5%.
This is not the right answer. Metformin is associated with weight loss or at least no weight gain.
This is the right answer. Because insulin secretion is unaltered, hypoglycemia is not a side effect of metformin used as monotherapy.
This is not the right answer. In the United Kingdom Prospective Diabetes Study, the metformin group experienced a 36% relative risk reduction in all-cause mortality.
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