Why was metformin recommended for this particular patient

The patient did not manage to decrease his blood sugar to desirable levels with diet and exercise. This is the indication for metformin - the only biguanide available - as monotherapy. This particularly concerns obese individuals, since the administration of the medicine is not associated with weight gain (as happens with other medicines) and potentially causes a small weight loss. Metformin is also useful in patients that need to maintain the weight loss achieved with diet and exercise. It is an equally effective antidiabetic medicine in obese and lean individuals with DM.

Risk factors for atheromatosis (obesity, smoking, sedentary life-style, hyperlipidaemia) are also taken into consideration, without being specific indications. It appears that metformin acts beneficially on a lot of the metabolic syndrome parameters (insulin-resistance syndrome) apart from glycaemia. More specifically, it decreases fasting hyperinsulinaemia, moderately improves the lipid profile and has some antithrombotic action as well, decreasing the PAI-1, the fibrinogen and the platelet aggregation.

In the UKPDS study, metformin was administered as an initial antidiabetic monotherapy in overweight Type 2 diabetic patients. Its administration decreased the macrovascular complications and increased survival, compared to the sulfonylureas or insulin that had the same long-term hypoglycaemic effects (follow-up of 10 years).

The dosage of metformin is 850 mg with a meal, with gradual increase up to a maximum of 2,550 mg (usually one tablet before each main meal) per day.

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