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*Only for medical professionals to read for reference.
Currently, metformin is the first-line medication recommended by the Global Diabetes Guidelines for the treatment of type 2 diabetes (T2DM).
In 2014, my country also launched the "Expert Consensus on the Clinical Application of Metformin", which was revised twice in 2016 and 2018.
Although the guidelines/consensus has increased the use rate of metformin in my country and promoted its standardized application, my country has a vast territory and the level of primary doctors is uneven.
The use rate of metformin is still low, and many primary doctors or patients still have problems.
Misunderstanding of metformin.
In order to further promote the standardized use of metformin and help grassroots diabetes management, recently, the Chinese People’s Liberation Army General Hospital Endocrinology Professor Mu Yoshiaki, Nanjing Gulou Hospital Endocrinology Professor Zhu Dalong and other well-known domestic endocrinologists jointly wrote "Metformin and Diabetes Treatment— -Hundred Questions and Answers", and held a new book release conference.
After Professor Mu Yiming attended the press conference of "Metformin and Diabetes Treatment-One Hundred Questions and One Answer", one of the editors of the book, Professor Yiming of the Endocrinology Department of the Chinese People's Liberation Army General Hospital, discussed the advantages and clinical value of metformin, and the "Metformin" And Diabetes Treatment—A Hundred Questions and a Hundred Answers" in the role of primary doctors, expounded my views.
Metformin, a “first-line”, is simple but not simple.
As early as 1957, Merck's Gwazhi, as the original drug of metformin, had been used clinically for the first time.
In the past 10 years, the first-line core position of metformin in the guideline update process of various countries has become more and more clear.
In 2005, the International Diabetes Federation (IDF) emphasized in the "Global Diabetes Management Guidelines" that regardless of obesity, T2DM treatment should be treated with metformin after lifestyle interventions have been adopted [1], and many domestic and foreign guidelines have followed this.
Maintaining a high degree of consistency, metformin has been used as the first-line medication for the treatment of T2DM[2-5].Excellent efficacy and multiple benefits are the reasons why metformin is favored by the guidelines.
Metformin can reduce the glycosylated hemoglobin (HbA1c) of Chinese newly diagnosed T2DM patients by 1.
8% (including placebo effect) and is not affected by weight [6].
Compared with other oral hypoglycemic drugs as first-line treatment, metformin is used as first-line treatment The second oral hypoglycemic agent or combined insulin treatment is required for patients at the latest [7], and the probability of subsequent adjustments to the treatment plan is also the lowest [8], so early use of metformin is a very cost-effective treatment plan.
Professor Mu Yiming pointed out that metformin also brings multiple benefits besides lowering blood sugar.
A number of studies have shown that metformin can significantly reduce plasma triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) in patients with T2DM [9, 10]; Metformin can reduce weight and improve non-alcoholic properties The role of fatty liver [11].
Moreover, studies have found that long-term treatment of metformin is significantly related to the decreased risk of cardiovascular events in newly diagnosed T2DM patients and T2DM patients with existing cardiovascular diseases [12].
Other studies have suggested that metformin also has the potential for renal protection [13].
Therefore, even with frequent new drugs in recent years, metformin is still firmly in the forefront.
The safety is good, and special patients need individualized treatment.
Professor Yoshiaki Mu believes that in terms of safety, metformin has also delivered a satisfactory answer.
Metformin is absorbed through the gastrointestinal tract for blood circulation.
It hardly binds to plasma albumin, does not undergo liver metabolism, does not compete with liver P450 enzymes, and does not degrade in the body.
Therefore, metformin has no hepatotoxicity and liver function within the recommended dose range.
Normal people will not cause liver damage [11].
Metformin is mainly excreted from the urine through the renal tubules in its original form, with rapid clearance, about 90% clearance within 12-24 hours, and its renal clearance rate is about 3.
5 times the creatinine clearance rate [11].
Therefore, metformin itself does not damage the kidneys [11].
In addition, there is no definite evidence to support the use of metformin and lactic acidosis [11].
Professor Mu Yiming pointed out that the main adverse reaction of metformin is gastrointestinal reactions, which can be alleviated by starting a small dose, gradually increasing the dose, or using sustained-release preparations (such as Govazin XR).
A mild gastrointestinal reaction is not an absolute bad thing.
For obese patients, it helps control appetite and reduce weight.
Professor Mu Yiming emphasized that the use of metformin in clinical practice should focus on individualized treatment.
For example, in patients with renal insufficiency, the renal clearance of metformin decreases, which can cause the accumulation of metformin.
Therefore, when metformin is used in patients with renal insufficiency, the dosage should be adjusted or stopped according to the renal function [11], glomerular filtration When the eGFR is 45-59mL/min/1.
73m2, the dose needs to be adjusted, and the eGFR<45mL/min/1.
73m2 needs to be stopped.
Efforts to improve the current status of medications and help diabetes management.
At present, the clinical application of metformin in my country, especially the use of primary medical staff, still has certain problems, such as the unsatisfactory use rate and the mistaken belief that metformin hurts the liver and kidneys.
In addition, the continuous listing of new hypoglycemic drugs has also brought challenges to the therapeutic status of metformin.
It must be recognized that since the first metformin preparation, glutamate, has been applied to the clinic, it has gone through more than 60 years of ups and downs.
Its efficacy and safety have been fully verified, with clear adverse reactions and specific use in special populations.
Plan.
In a number of clinical trials of hypoglycemic drugs, metformin is often used as a control drug.
From mechanism to clinical, "Metformin and Diabetes Treatment-Hundred Questions and Answers" provides simple and clear answers through the "soul torture" of metformin, referring to a large number of relevant randomized controlled studies (RCT) and real world studies (RWE) , Aims to guide the majority of grassroots doctors to correctly understand and use metformin, improve the current situation of medication, and help diabetes management.
Summary After more than 60 years of trials and hardships, the efficacy and safety of metformin have been extensively verified, and it is the cornerstone of diabetes treatment.
In addition to lowering blood sugar, metformin can also bring multiple benefits such as lipid regulation, weight loss, and cardiovascular protection.
It is hoped that the publication of "Metformin and Diabetes Treatment-Hundred Questions and Answers" can improve the current status of metformin's medication use among primary doctors in my country and help diabetes management.
[12] Holman RR, Paul SK, Bethel MA, et al.
10-year follow-up of intensive glucose control in type 2 diabetes[J].
N Engl J Med, 2008, 359:1577-1589.
[13]Muskiet MH , SmitsMM, Morsink LM, et al.
The gut-renal axis: do incretin ⁃ based agents conferrenoprotection in diabetes[J]? Nat Rev Nephrol, 2014, 10: 88-103.
For submission/reprint/business cooperation, please contact: pengsanmei@yxj.
org.
cn
Currently, metformin is the first-line medication recommended by the Global Diabetes Guidelines for the treatment of type 2 diabetes (T2DM).
In 2014, my country also launched the "Expert Consensus on the Clinical Application of Metformin", which was revised twice in 2016 and 2018.
Although the guidelines/consensus has increased the use rate of metformin in my country and promoted its standardized application, my country has a vast territory and the level of primary doctors is uneven.
The use rate of metformin is still low, and many primary doctors or patients still have problems.
Misunderstanding of metformin.
In order to further promote the standardized use of metformin and help grassroots diabetes management, recently, the Chinese People’s Liberation Army General Hospital Endocrinology Professor Mu Yoshiaki, Nanjing Gulou Hospital Endocrinology Professor Zhu Dalong and other well-known domestic endocrinologists jointly wrote "Metformin and Diabetes Treatment— -Hundred Questions and Answers", and held a new book release conference.
After Professor Mu Yiming attended the press conference of "Metformin and Diabetes Treatment-One Hundred Questions and One Answer", one of the editors of the book, Professor Yiming of the Endocrinology Department of the Chinese People's Liberation Army General Hospital, discussed the advantages and clinical value of metformin, and the "Metformin" And Diabetes Treatment—A Hundred Questions and a Hundred Answers" in the role of primary doctors, expounded my views.
Metformin, a “first-line”, is simple but not simple.
As early as 1957, Merck's Gwazhi, as the original drug of metformin, had been used clinically for the first time.
In the past 10 years, the first-line core position of metformin in the guideline update process of various countries has become more and more clear.
In 2005, the International Diabetes Federation (IDF) emphasized in the "Global Diabetes Management Guidelines" that regardless of obesity, T2DM treatment should be treated with metformin after lifestyle interventions have been adopted [1], and many domestic and foreign guidelines have followed this.
Maintaining a high degree of consistency, metformin has been used as the first-line medication for the treatment of T2DM[2-5].Excellent efficacy and multiple benefits are the reasons why metformin is favored by the guidelines.
Metformin can reduce the glycosylated hemoglobin (HbA1c) of Chinese newly diagnosed T2DM patients by 1.
8% (including placebo effect) and is not affected by weight [6].
Compared with other oral hypoglycemic drugs as first-line treatment, metformin is used as first-line treatment The second oral hypoglycemic agent or combined insulin treatment is required for patients at the latest [7], and the probability of subsequent adjustments to the treatment plan is also the lowest [8], so early use of metformin is a very cost-effective treatment plan.
Professor Mu Yiming pointed out that metformin also brings multiple benefits besides lowering blood sugar.
A number of studies have shown that metformin can significantly reduce plasma triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) in patients with T2DM [9, 10]; Metformin can reduce weight and improve non-alcoholic properties The role of fatty liver [11].
Moreover, studies have found that long-term treatment of metformin is significantly related to the decreased risk of cardiovascular events in newly diagnosed T2DM patients and T2DM patients with existing cardiovascular diseases [12].
Other studies have suggested that metformin also has the potential for renal protection [13].
Therefore, even with frequent new drugs in recent years, metformin is still firmly in the forefront.
The safety is good, and special patients need individualized treatment.
Professor Yoshiaki Mu believes that in terms of safety, metformin has also delivered a satisfactory answer.
Metformin is absorbed through the gastrointestinal tract for blood circulation.
It hardly binds to plasma albumin, does not undergo liver metabolism, does not compete with liver P450 enzymes, and does not degrade in the body.
Therefore, metformin has no hepatotoxicity and liver function within the recommended dose range.
Normal people will not cause liver damage [11].
Metformin is mainly excreted from the urine through the renal tubules in its original form, with rapid clearance, about 90% clearance within 12-24 hours, and its renal clearance rate is about 3.
5 times the creatinine clearance rate [11].
Therefore, metformin itself does not damage the kidneys [11].
In addition, there is no definite evidence to support the use of metformin and lactic acidosis [11].
Professor Mu Yiming pointed out that the main adverse reaction of metformin is gastrointestinal reactions, which can be alleviated by starting a small dose, gradually increasing the dose, or using sustained-release preparations (such as Govazin XR).
A mild gastrointestinal reaction is not an absolute bad thing.
For obese patients, it helps control appetite and reduce weight.
Professor Mu Yiming emphasized that the use of metformin in clinical practice should focus on individualized treatment.
For example, in patients with renal insufficiency, the renal clearance of metformin decreases, which can cause the accumulation of metformin.
Therefore, when metformin is used in patients with renal insufficiency, the dosage should be adjusted or stopped according to the renal function [11], glomerular filtration When the eGFR is 45-59mL/min/1.
73m2, the dose needs to be adjusted, and the eGFR<45mL/min/1.
73m2 needs to be stopped.
Efforts to improve the current status of medications and help diabetes management.
At present, the clinical application of metformin in my country, especially the use of primary medical staff, still has certain problems, such as the unsatisfactory use rate and the mistaken belief that metformin hurts the liver and kidneys.
In addition, the continuous listing of new hypoglycemic drugs has also brought challenges to the therapeutic status of metformin.
It must be recognized that since the first metformin preparation, glutamate, has been applied to the clinic, it has gone through more than 60 years of ups and downs.
Its efficacy and safety have been fully verified, with clear adverse reactions and specific use in special populations.
Plan.
In a number of clinical trials of hypoglycemic drugs, metformin is often used as a control drug.
From mechanism to clinical, "Metformin and Diabetes Treatment-Hundred Questions and Answers" provides simple and clear answers through the "soul torture" of metformin, referring to a large number of relevant randomized controlled studies (RCT) and real world studies (RWE) , Aims to guide the majority of grassroots doctors to correctly understand and use metformin, improve the current situation of medication, and help diabetes management.
Summary After more than 60 years of trials and hardships, the efficacy and safety of metformin have been extensively verified, and it is the cornerstone of diabetes treatment.
In addition to lowering blood sugar, metformin can also bring multiple benefits such as lipid regulation, weight loss, and cardiovascular protection.
It is hoped that the publication of "Metformin and Diabetes Treatment-Hundred Questions and Answers" can improve the current status of metformin's medication use among primary doctors in my country and help diabetes management.
[12] Holman RR, Paul SK, Bethel MA, et al.
10-year follow-up of intensive glucose control in type 2 diabetes[J].
N Engl J Med, 2008, 359:1577-1589.
[13]Muskiet MH , SmitsMM, Morsink LM, et al.
The gut-renal axis: do incretin ⁃ based agents conferrenoprotection in diabetes[J]? Nat Rev Nephrol, 2014, 10: 88-103.
For submission/reprint/business cooperation, please contact: pengsanmei@yxj.
org.
cn
