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Metformin

Metformin, marketed under the trade name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes, particularly in people who are overweight. It is also used in the treatment of polycystic ovary syndrome. It is not associated with weight gain. It is taken by mouth. Metformin is generally well tolerated. Common side effects include diarrhea, nausea, and abdominal pain. It has a low risk of causing low blood sugar. High blood lactic acid level is a concern if the medication is prescribed inappropriately or in overly large doses. It should not be used in those with significant liver disease or kidney problems. While no clear harm comes from use during pregnancy, insulin is generally preferred for gestational diabetes. Metformin is a biguanide antihyperglycemic agent. It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues. Metformin was discovered in 1922. French physician Jean Sterne began study in humans in the 1950s. It was introduced as a medication in France in 1957 and the United States in 1995. Metformin is on the World Health Organization's List of Essential Medicines, which lists the most effective and safe medicines needed in a health system. Metformin is the most widely used medication for diabetes taken by mouth. It is available as a generic medication. The wholesale price in the developed world was between US$0.21 and $5.55 per month as of 2014. In the United States, it costs US$5 to US$25 per month. In 2016, it was the fourth-most prescribed medication in the United States, with more than 81 million prescriptions. Metformin is used to lower the blood sugar in those with type 2 diabetes; it is also used as a second line agent for infertility in those with polycystic ovary syndrome. The American Diabetes Association and the American College of Physicians each recommend metformin as a first-line agent to treat type 2 diabetes. It is as effective as repaglinide and more effective than all other oral diabetes mellitus type 2 drugs. The UK Prospective Diabetes Study, a large clinical trial performed in 1980–90s, provided evidence that metformin reduced the rate of adverse cardiovascular outcomes in overweight patients with type 2 diabetes relative to other antihyperglycemic agents. However, accumulated evidence from other and more recent trials reduced confidence in the efficacy of metformin for cardiovascular disease prevention. Outcomes are improved even in those with some degree of kidney disease, heart failure, or chronic liver disease. Treatment guidelines for major professional associations including the European Association for the Study of Diabetes, the European Society for Cardiology, and the American Diabetes Association, now describe evidence for the cardiovascular benefits of metformin as equivocal. In 2017, the American College of Physicians's guidelines were updated to recognize metformin as the first-line treatment for type 2 diabetes. These guidelines supersede earlier reviews. For example, a 2014 review found tentative evidence that people treated with sulfonylureas had a higher risk of severe low blood sugar events (RR 5.64), though their risk of nonfatal cardiovascular events was lower than the risk of those treated with metformin (RR 0.67). Not enough data were available at that time to determine the relative risk of death or of death from heart disease.

[ "Insulin", "Diabetes mellitus", "DAPAGLIFLOZIN/METFORMIN", "Alogliptin", "Orthopedic cement", "Glucophage XR", "Arachnoid Membrane" ]
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