tailieunhanh - Diagnosis and Management of Pituitary Disorders - part 3

Các thành viên duy nhất của lớp biguanide có sẵn để sử dụng lâm sàng là metformin. Metformin là một đại lý được thành lập để điều trị bệnh tiểu đường type 2 và đã được chứng minh là làm giảm sản lượng glucose ở gan | Chapter 6 Therapies for Delay or Prevention of Type 2 Diabetes 87 limit their effectiveness. For individuals in whom lifestyle interventions may be insufficient or contraindicated by other comorbidities pharmacological therapy to prevent type 2 diabetes may be a viable option Table 1 . ORAL HYPOGLYCEMIC AGENTS Biguanides The sole member of the biguanide class available for clinical use is metformin. Metformin is an established agent for treatment of type 2 diabetes and has been shown to reduce hepatic glucose output and improve insulin sensitivity. The Biguanides and Prevention of Risks in Obesity BIGPRO trial was one of the first to examine the potential of metformin to improve the metabolic profile of patients with prediabetes 10 . BIGPRO enrolled patients without known cardiovascular disease or diabetes and with an elevated waist-to-hip ratio thought to indicate the presence of insulin resistance. Subjects were randomized to 850 mg of metformin twice daily or placebo and followed for a mean of 1 yr. Among the 324 patients available for analysis those randomized to metformin n 164 demonstrated improvements in weight loss kg versus kg in the placebo group p fasting plasma glucose increased by versus mg dL p and LDL maintenance versus a mg dL increase in the placebo group p at 1 yr. Rates of conversion to diabetes and cardiovascular event rates in the trial were too low to calculate an effect of metformin on these endpoints. Because of promising results like those seen in the BIGPRO trial metformin was selected as a treatment arm in the largest trial of diabetes prevention the DPP 9 . The DPP enrolled 3234 subjects with IGT and randomized them to intensive lifestyle intervention 850 mg metformin twice daily or placebo. Although less effective than the 58 reduction in diabetes incidence seen in the intensive lifestyle intervention group metformin did result in a 31 drop in progression to diabetes p for both .