Vol. 5, Issue 7 (2019)
Relevance of metformin as a first line in type 2 diabetes mellitus
Author(s): Dr. Gururaj Krishnarao Kulkarni, Dr. Jaishree G Kulkarni
Abstract: Background: Metformin is most commonly prescribed drug in the management of diabetes. There is a global increase in the obesity prevalence in children, adolescents and it is accompanied by the appearance and there is increased prevalence of insulin resistance, prediabetes and type 2 diabetes mellitus (T2DM). All Guidelines have recommended Metformin in Type 2 Diabetes Mellitus patient as a first line drug. Metformin acts by inhibiting production of hepatic glucose and increased uptake of glucose in peripheral tissues. In obese patients apart from glycemic control the Metformin have shown additive effects in controlling the lipids and it has been document to also have a Cardio- protective action. Apart from usage of metformin in treating diabetes it can also be used in other conditions like prediabetes, obesity, PCOD (polycystic ovary disease), NASH-non-alcoholic fatty liver disease. It is a drug of choice of physician due to its insulin sensitizing action. It is therefore a primary drug of choice in these conditions for both prevention and treatment. Methods: 124 patients were selected between the age group of 26 to 40 years whose BMIs was between 28- 35 kg/m 2 who were diagnosed with type 2 diabetes mellitus. Inclusion criteria: 1) Fasting plasma glucose concentrations more than 126mg/dl but less than 180mg/dl and PPBG more than 200 mg/dl but less than 299mg/dl 2) hemoglobin A1C concentrations 6.5-8.5%. Excluding criteria: 1) Patient with BMI more than 35 and less than 28were excluded from the study. 2) HB1C more than 8.5 3) Patient with comorbidities were excluded from the study. 4) Elderly patient 5) any other systemic organ dysfunction 6) if FBS>200mg/dl, PPBS >300mg/dl Results: This study has shown better glycemic level controls when patient were started on medication than compared to placebo group. Fasting Blood glucose level in the Metformin group of patients was significantly reduced than in placebo group. Metformin group of patient had a reduction of BMI by a mean of 1.12 kg/m2 when compared with placebo. Metformin group of patient had significant reduction of HbA1c.This signifies the metformin still holds the good in management of obese diabetic patients. Conclusions: Metformin is the most commonly prescribed therapy for patients with T2DM. It has a good safety profile and is associated with low cost. The study has confirmed that usage of metformin as an initial drug help in getting the glycemic control unless contraindicated. Patients treated with metformin had weight reduction in obese children and adolescents. Apart from reduction of BMI, metformin also helps in reduction of resistance to insulin in hyperinsulinemia children and adolescents who are obese. Longer-term studies in different populations are required to establish metformin role in the treatment of overweight children.
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