Fujimoto S
Department of Metabolism and Clinical Nutrition, Kyoto University.
Nihon Rinsho. 1999 Mar;57(3):657-62.
Metformin, one of the biguanides, is an oral hypoglycemic agent which acts primarily by decreasing hepatic glucose output and by increasing peripheral glucose disposal, therefore it has different hypoglycemic mechanism from that of sulfonylureas. The hypoglycemic effects of metformin are observed not only in obese NIDDM patients, but also in non-obese NIDDM patients. Moreover, addition of metformin improves glycemic control in patients with suboptimal glycemic control while taking maximum sulfonylurea therapy. Therefore, it is complementary to sulfonylurea therapy and represents a useful additional drug for the treatment, irrespective of obesity. The rare but serious condition of lactic acidosis should be kept in mind as a potential side effect, however, if metformin is avoided in patients with contraindications, the medication is very safe.
二甲双胍是双胍类药物之一，是一种口服降糖药，其主要作用机制是减少肝脏葡萄糖输出并增加外周葡萄糖利用，因此其降糖机制与磺脲类药物不同。二甲双胍不仅在肥胖的非胰岛素依赖型糖尿病（NIDDM）患者中具有降糖作用，在非肥胖的NIDDM患者中也有此作用。此外，在接受最大剂量磺脲类药物治疗但血糖控制仍欠佳的患者中加用二甲双胍可改善血糖控制。因此，无论患者是否肥胖，二甲双胍都是磺脲类药物治疗的补充药物，是一种有效的辅助治疗药物。不过，应牢记乳酸酸中毒这种罕见但严重的情况是其潜在的副作用，如果对有禁忌证的患者避免使用二甲双胍，那么该药物是非常安全的。
