Metformin is a first-line antihyperglycemic drug: from mechanisms of action to NICE guidelines

March 6, 2023
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Diabetes mellitus has been one of the central topics in the field of health care. Well-known international organizations recommend metformin as the main oral antihyperglycemic drug in addition to lifestyle control. The antihyperglycemic effect of metformin is realized in the liver due to a significant reduction in the reserves of pyruvate and dihydroxyacetone phosphate, which are the main substrates of gluconeogenesis. The discovery of metformin’s various pleiotropic activities, including antiviral, antibacterial, anticancer, anti-inflammatory, and antiaging effects, has become the basis for its use in patients with various comorbidities. According to UK National Institute for Health and Care Improvement guidelines, metformin should be considered as a first-line antihyperglycemic drug in overweight and obese patients, as well as in non-overweight patients. Metformin has additional cardioprotective properties, it can be combined with glucagon-like peptide-1 receptor agonists and sodium-dependent glucose co-transporter type 2 inhibitors, and used in concomitant moderate renal failure.

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