Metformina, a 50 años de su uso: Eficacia, tolerancia, seguridad y nuevas indicaciones

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Abstract

La Metformina comenzó a utilizarse en el tratamiento de la diabetes mellitus tipo 2 en 1957 en Europa y en 1995 en EE. UU. Actualmente es el antihiperglucemiante oral mas frecuentemente recetado en todo el mundo. En 1998 el United Kingdom Prospective Diabetes Study, demostró los efectos antiaterogénicos de metformina y más tarde se descubrió que mejoraba muchos componentes del síndrome de resistencia a insulina (síndrome metabólico). El US Diabetes Prevention Program, demostró el potencial de metformina en la prevención de la diabetes. Su eficacia, seguridad, múltiples beneficios cardiovasculares y metabólicos, y la capacidad de poder utilizarse en combinación con todos los demás fármacos antidiabéticos, incluida la insulina, han convertido a metformina en el fármaco oral de primera línea para el tratamiento de los pacientes con diabetes mellitus tipo 2. En los últimos años ha surgido evidencia para indicar metformina en pacientes no diabéticos, principalmente aquellos con síndrome metabólico, intolerantes a la glucosa y mujeres que buscan un embarazo y padecen del síndrome de ovario poliquístico. Además podría mejorar las características clínicas de los estados resistentes a insulina, aparte de la diabetes tipo 2. Su papel en la prevención del cáncer podría ser otro de los desarrollos de metformina en el futuro. El objetivo de esta revisión es actualizar sobre las nuevas directrices de este fármaco.

Translated abstract

Metformin began to be used in the treatment of type 2 diabetes mellitus in 1957 in Europe and 1995 in EE. UU. He is currently the most frequently prescribed oral anti-hyperglycaemic worldwide. In 1998, the United Kingdom Prospective Diabetes Study demonstrated antiatherogenic effects of metformin and later discovered that improved many components of insulin resistance syndrome (metabolic syndrome). The U.S. Diabetes Prevention Program demonstrated the potential of metformin in preventing diabetes. Its efficacy, safety, multiple cardiovascular and metabolic benefits, and the ability to be used in combination with all other antidiabetic agents, including insulin, metformin has made in the first line oral drug for the treatment of patients with diabetes mellitus type 2. In recent years evidence has surfaced to indicate metformin in nondiabetic patients, primarily those with metabolic syndrome, glucose intolerant and women seeking a pregnancy and suffer from polycystic ovary syndrome. It could also improve the clinical characteristics of insulin resistant states, apart from type 2 diabetes. Its role in cancer prevention could be another of the developments of metformin in the future. The objective of this review is to update on the new guidelines of the drug.

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Most cited references 24

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Metformin in polycystic ovary syndrome: systematic review and meta-analysis.

Christopher J. Lord, J. Norman, Ingrid Flight (2003)

To assess the effectiveness of metformin in improving clinical and biochemical features of polycystic ovary syndrome. Systematic review and meta-analysis. Randomised controlled trials that investigated the effect of metformin compared with either placebo or no treatment, or compared with an ovulation induction agent. 13 trials were included for analysis, including 543 women with polycystic ovary syndrome that was defined by using biochemical or ultrasound evidence. Pregnancy and ovulation rates. Secondary outcomes of clinical and biochemical features of polycystic ovary syndrome. Meta-analysis showed that metformin is effective in achieving ovulation in women with polycystic ovary syndrome, with odds ratios of 3.88 (95% confidence interval 2.25 to 6.69) for metformin compared with placebo and 4.41 (2.37 to 8.22) for metformin and clomifene compared with clomifene alone. An analysis of pregnancy rates shows a significant treatment effect for metformin and clomifene (odds ratio 4.40, 1.96 to 9.85). Metformin has an effect in reducing fasting insulin concentrations, blood pressure, and low density lipoprotein cholesterol. We found no evidence of any effect on body mass index or waist:hip ratio. Metformin was associated with a higher incidence of nausea, vomiting, and other gastrointestinal disturbance. Metformin is an effective treatment for anovulation in women with polycystic ovary syndrome. Its choice as a first line agent seems justified, and there is some evidence of benefit on variables of the metabolic syndrome. No data are available regarding the safety of metformin in long term use in young women and only limited data on its safety in early pregnancy. It should be used as an adjuvant to general lifestyle improvements and not as a replacement for increased exercise and improved diet.

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Non-alcoholic fatty liver disease and the metabolic syndrome: effects of weight loss and a review of popular diets. Are low carbohydrate diets the answer?

H Gill, Ching-yi Wu (2006)

Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of fat-induced liver injury, ranging from relatively benign steatosis to cirrhosis and liver failure. The presence of obesity and insulin resistance is strongly associated with non-alcoholic fatty liver and confers on it a greater risk of histologically advanced disease. There is a growing concern in the medical profession as the prevalence of this disease continues to rise in parallel with the rise in obesity and the metabolic syndrome. Treatment options are limited and dietary weight loss is often advised. Low fat diets are difficult to adhere to and recent studies have shown the potential of low carbohydrate diets for weight loss and improving insulin resistance. Thus far, no study has evaluated the effect of low carbohydrate diets on NAFLD. Future studies will be required to address this question and others with regards to the nutritional adequacy and long-term side effects of these diets.

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Guidelines for glycemic control.

Stephen Clement (2003)

Glycemic control in diabetes patients continues to evolve as new medications are introduced and clinical trial data become available. The American Diabetes Association (ADA) guidelines for 2004, for the first time, provide targets for both preprandial and postprandial glucose levels. The ADA, however, does not provide guidelines regarding specific medication therapy. This paper provides a detailed treatment algorithm that is easy to follow for nurse practitioners as well as primary care providers. Progress in our understanding of diabetes and new therapeutic agents will dictate modifications of treatment targets and guidelines, with the goal of making euglycemia achievable for all patients with diabetes.