What do we do with metformin?

Abstract

In recent years, a change has been observed in the approach of treatment in people with type 2 Diabetes, where the preferred drugs for treatment are those that, in addition to the hypoglycemic effect, have demonstrated a benefit on cardiorenometabolic risk. However, drugs such as metformin, which is powerful, with important demonstrated benefits, should not be overlooked. For 60 years, metformin was considered the drug of choice in patients with type 2 diabetes along with lifestyle changes. Its therapeutic target is the inhibition of gluconeogenesis, in addition to having anti-inflammatory and immunomodulatory properties in various diseases related to the immune system through AMPK-dependent and independent mechanisms that involve both the innate and adaptive immune systems. In the glucocentric approach, Metformin achieves, by reducing 0.6.- 1% of HbA1c. It significantly reduces diabetes-related mortality by 42%, IAM by 39%, stroke by 41%, and microvascular complications by 29% (UKPDS). In recent years, the guidelines3 that, after lifestyle changes, diabetes education, avoiding clinical inertia and social conditions, the use of antidiabetic medication should be considered, taking into account the person's comorbidities and therapeutic objectives. Although new drugs such as iSGLT2 and AR-GLP1 have demonstrated renal and cardiovascular benefits, metformin remains a vitally important drug in the therapeutic arsenal with proven safety and benefits in the treatment of people with type 2 diabetes.