Insulin sensitizers

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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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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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