Drugs online research references
J Clin Endocrinol Metab. 1991 Dec;73(6):1294-301.
Mechanism of metformin action in obese and lean noninsulin-dependent diabetic subjects.
DeFronzo RA, Barzilai N, Simonson DC.
Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7877.
The effect of metformin on glucose metabolism was examined in eight obese (percent ideal body weight, 151 +/- 9%) and six lean (percent ideal body weight, 104 +/- 4%) noninsulin-dependent diabetic (NIDD) subjects before and after 3 months of metformin treatment (2.5 g/day). Fasting plasma glucose (11.5-8.8 mmol/L), hemoglobin-A1c (9.8-7.7%), oral glucose tolerance test response (20.0-17.0 mmol/L; peak glucose), total cholesterol (5.67-4.71 mmol/L), and triglycerides (2.77-1.52 mmol/L) uniformly decreased (P less than 0.05-0.001) after metformin treatment; fasting plasma lactate increased slightly from baseline (1.4 to 1.7 mmol/L; P = NS). Body weight decreased by 5 kg in obese NIDD subjects, but remained constant in lean NIDD. Basal hepatic glucose production declined in all diabetics from 83 to 61 mg/m2.min (P less than 0.01), and the decrease correlated (r = 0.80; P less than 0.01) closely with the fall in fasting glucose concentration. Fasting insulin (115 to 79 pmol/L) declined (P less than 0.05) after metformin. During a 6.9 mmol/L hyperglycemic clamp, glucose uptake increased in every NIDD subject (113 +/- 15 to 141 +/- 12 mg/m2.min; P less than 0.001) without a change in the plasma insulin response. During a euglycemic insulin clamp, total glucose uptake rose in obese NIDD subjects (121 +/- 10 to 146 +/- 9 mmol/m2.min; P less than 0.05), but decreased slightly in lean NIDD (121 +/- 10 to 146 +/- 0.5; P = NS). Hepatic glucose production was suppressed by more than 80-90% in all insulin clamp studies before and after metformin treatment. In conclusion, metformin lowers the fasting plasma glucose and insulin concentrations, improves oral glucose tolerance, and decreases plasma lipid levels independent of changes in body weight. The improvement in fasting glucose results from a reduction in basal hepatic glucose production. Metformin per se does not enhance tissue sensitivity to insulin in NIDD subjects. The improvement in glucose metabolism under hyperglycemic, but not euglycemic, conditions suggests that metformin augments glucose-mediated glucose uptake. Metformin has no stimulatory effect on insulin secretion.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1955512&dopt=Abstract
Postgrad Med J. 1979;55 Suppl 2:22-6.
Oral hypoglycaemic drugs--our current practice.
Timoney FJ.
The pattern of prescribing in a diabetic clinic population extending over a 25 year period is examined. The number of patients studied, 4355, was divided into three categories according to age at onset of diabetes, those diagnosed before 15 years of age, those diagnosed between 15 and 45 years and those diagnosed after the age of 45 years. A reduction in the proportion of maturity-onset diabetics, in whom oral hypoglycaemic agents were used, is noted, when treatment prior to 1970 is compared with that post-1970. This reduction, from 36% of the total population prior to 1970 to 29% after 1970 was accompanied by an increase in the proportion treated by diet alone for the same period of from 17% to 30%. For the past three years metformin has replaced phenformin as the biguanide of choice in the clinic.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=482195&dopt=Abstract
S Afr Med J. 1979 Sep 1;56(12):467-75.
Diabetes newly diagnosed during pregnancy: A 4-year study at Groote Schuur Hospital.
Coetzee EJ, Jackson WP.
As a result of active screening for gestational diabetes of the population attending various antenatal clinics in the Cape Peninsula, 127 patients with a repeatedly diabetic glucose tolerance test (GTT) were discovered; in many the GTT was grossly abnormal. The most useful screening factor was repeated glycosuria. Because they had booked late, 22 patients received virtually no treatment, and 1 patient aborted. Treatment of the remaining 104 patients was achieved principally by regulating diet, but when this failed metformin or glibenclamide therapy was instituted. Insulin was used when diet and oral drugs failed. Diabetic control was considered adequate if fasting blood glucose levels remained below 5,5 mmol/l and if postprandial levels were below 7 mmol/l. Most patients (67) were well controlled on a strict dietary regimen, and there were no perinatal deaths in this group. Glibenclamide and metformin, judging from this small series, appear to be safe for use in gestational diabetics. The overall perinatal mortality in treated patients was 10/1 000 as compared with an effective perinatal mortality of 145/1 000 in the 'untreated' group. Neonatal morbidity was similar to that in other reported series. Hypoglycaemia was seldom a problem and 79% of birth weights were between the 10th and the 90th percentiles.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=121638&dopt=Abstract
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