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Metformin is an oral medication commonly used to manage type 2 diabetes mellitus. It is often the first-line treatment due to its effectiveness, safety profile, and additional benefits beyond blood sugar control. Mechanism of Action Metformin primarily works by: Reducing Hepatic Glucose Production**: It decreases the amount of glucose produced by the liver, particularly by inhibiting gluconeogenesis (the process of generating glucose from non-carbohydrate sources). Increasing Insulin Sensitivity**: Metformin enhances the sensitivity of peripheral tissues (like muscle and fat) to insulin, facilitating better uptake of glucose from the bloodstream. Decreasing Intestinal Absorption of Glucose**: It may also reduce the absorption of glucose from the gastrointestinal tract. Indications Metformin is indicated for: Type 2 Diabetes Mellitus**: It is used to improve glycemic control in adults and children (larger than & equal to 10 years), typically in conjunction with diet and exercise. Polycystic Ovary Syndrome (PCOS)**: Off-label, it is sometimes used to manage symptoms related to insulin resistance in women with PCOS. Dosage and Administration Formulations**: Metformin is available in immediate-release and extended-release formulations. Dosing**: The initial dose is usually low, gradually increased based on tolerance and glycemic control. The maximum dose typically does not exceed 2,000-2,500 mg per day, depending on the formulation. Side Effects Common side effects include: Gastrointestinal issues: Nausea, vomiting, diarrhea, abdominal discomfort, and flatulence (often transient). Lactic acidosis: A rare but serious side effect, particularly in individuals with renal impairment or contraindicating conditions. Contraindications Metformin is contraindicated in: Severe renal impairment (eGFR less than 30 mL/min) Acute or chronic metabolic acidosis, including diabetic ketoacidosis Hypersensitivity to metformin Cautions Renal Function Monitoring**: Kidney function should be assessed before starting therapy and regularly monitored during treatment. Use in Specific Populations**: Caution is advised in patients with liver disease, heart failure, or those undergoing procedures involving contrast media, as these can increase the risk of lactic acidosis. Benefits Beyond Glycemic Control Metformin has additional benefits, including: Weight Management** It is generally weight-neutral or may even promote modest weight loss, making it suitable for overweight individuals with type 2 diabetes. Cardiovascular Benefits**: Some studies suggest that metformin may have cardiovascular protective effects. Conclusion Metformin is a cornerstone in the management of type 2 diabetes, known for its efficacy in lowering blood sugar levels, safety profile, and additional health benefits. As with any medication, it should be prescribed and monitored by a healthcare professional, ensuring that patients receive the most appropriate and effective treatment for their condition. Regular follow-up and lifestyle modifications (diet and exercise) are essential components of diabetes management alongside metformin therapy.
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