Multidimensional effects of metformin in patients with type 2 diabetes
2017
Lyudmila A. Ruyatkina | Dmitriy S. Ruyatkin
In modern algorithms for the treatment of type 2 diabetes, metformin is positioned as a first-line drug, which, when the disease progresses, is universally combined with other groups of hypoglycemic drugs, including insulin. Review of literature demonstrates the multifaceted effects of metformin with its efficacy and extensive safety range, allowing the drug to be used not only for glycemic control but also for the management of cardiovascular risk factors. Here we present a retrospective study of whether cardiovascular safety of hypoglycemic drugs should be assessed, on the basis of which the idea of a “vulnerable patient” in the presence of diabetes can be formulated, and the necessity of joint management of such patients by an endocrinologist and cardiologist can be postulated. The mechanisms of macrovascular protection by the drug demonstrated in the UKPDS with the phenomenon of “metabolic memory” are analysed along with a discussion regarding their lipid-lowering and antisclerotic effects using modern analytical reviews. The features of the action of long form of the drug (Glucophage Long) are considered. The pleiotropic possibilities of metformin, the expansion of the present indications and the prospects of application as well as new hypotheses about its mechanism of action are discussed. The possible effects of the drug on the components of the “gastrointestinal tract–brain–liver” axis are discussed, and the effects of metformin on homeostasis due to the effect on the microbiota are presented.
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