Biguanides

Metformin, the only biguanide available, works primarily by decreasing hepatic glucose production. It has been available in other countries since 1957 and in the USA since 1995. It is currently the most widely prescribed diabetes agent in the USA. Metformin has the advantages of not causing hypoglycemia and being associated with weight loss. Although it was found in the United Kingdom Prospective Diabetes Study (UKPDS) to have a beneficial effect on CVD outcomes [9], this finding needs to be confirmed before metformin can be recommended for reduction of cardiovascular risk. The most common adverse effects are gastrointestinal. Lactic acidosis, a potentially fatal adverse effect, is extremely rare, and is associated almost exclusively with other risk factors such as renal or hepatic disease.

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