The most prescribed oral agent for T2DM metformin may also improve cardiovascular outcome, and reduce cancer risk. Metformin is underutilized according to a meeting yesterday when experts were discussing the growing use of metformin. New labelling in US indicates metformin use for patients with eGFR 30 or higher - opens up for even more patients. The evidence for T2DM is strong, especially compared with other oral agents, said prof Lipska, Prof of Yale Univ, USA.    

Metformin comes from the 1920s and originates from nature, from French lilac or goats rue (getruta in Swedish), Galega officianalis in Linnes nomenclature. The molecule was rediscovered in the 1950s and a huge prescriptions after the UKPDS 1998 showing reduction around 40% in micro- and macroangiopathy complications.   Metformin is metabolized in the liver. Metformin has the benefit of of lowering glucose production in the liver, increasing glucose utilization in the liver and also in the muscles.    

Prof Pollak, director of cancer prevention in Montreal, Canada told us that nowadays there is great interests in the drug around oncologists. Patients treated with metrformin had 2 years ago in a study unexpected low rates of cancer deaths and cancer incidence relative to patients treated with other drugs. Other population studies showed the same. Now there is more than 100 clinical trials ongoing to get more results.  Dr Pollak, said that metformin alters energy metabolism in such a way that it might be expected to have antineoplastic effects. "The final word on metformin and cancer is not in", Dr Pollak said.

UKPDS study 1998 showed 39% reduced risk for myocardial infarction and 36% reduction in all cause mortality. Later observatiuonal trials and national registars hav e shown similar benefits in cardiovascular outcome, Dr Holman said. A new trial Glucose Lowering in Non-diabetic hyperglycemia trial GLINT will enroll 12000 patients in an attempt to provide better data and more definitive answers of the mechanisms of metformins positive effects on heart and cancer outcome, Dr Holman said.

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