Although available internationally for decades, metformin, a biguanide, was not released in the United States until 1995 . An earlier bigua-nide, phenformin, was removed from the market in the 1970s because of an association with lactic acidosis . 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 . 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 . 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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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.