Insulin sensitizers

Biguanides

Although available internationally for decades, metformin, a biguanide, was not released in the United States until 1995 [73]. An earlier bigua-nide, phenformin, was removed from the market in the 1970s because of an association with lactic acidosis [74]. In contrast to the sulfonylureas, metformin does not stimulate insulin secretion [75,76]. Metformin is the only biguanide that is available for clinical use (Box 2). Its efficacy as monotherapy and in combination with other agents is well-established [73]. Metformin is the only drug that has been shown to decrease cardiovascular events in patients who have type 2 diabetes mellitus independent of glycemic control [11]. Although metformin has a small effect as a peripheral insulin sensitizer, its main mechanism is inhibiting hepatic gluconeogenesis. Nevertheless, metformin treatment decreases plasma

Box 2. Advantages and disadvantages of metformin

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