Compared to other oral agents, metformin has several advantages. The United
Kingdom Prospective Diabetes Study (UKPDS) demonstrated cardiovascular protective
effects. Patients treated with metformin had reductions of 32% for any
diabetes-related end point (microvascular and macrovascular), 42% for diabetesrelated
deaths, and 39% for myocardial infarction compared to those treated
with conventional less-aggressive therapy. Patients receiving metformin had more
impressive risk reductions in any diabetes-related end point and all-cause mortality
than those receiving sulfonylurea or insulin with similar A1c improvement [3].
Additionally, metformin may cause modest weight loss, it is relatively unlikely to
cause hypoglycemia, and it has salutary effects on plasma lipid levels. With longterm
therapy, metformin produces a 10% to 20% reduction in plasma triglyceride
levels due to decreased hepatic synthesis of very-low-density lipoprotein, a 5% to
10% decrease in plasma total cholesterol, and small increases in plasma high-density
lipoprotein cholesterol (HDL) [2]. Its side effects are generally limited and mild,
and it is inexpensive. For all of these reasons, metformin is generally considered
the first-line oral agent for the treatment of type 2 diabetes [1]. Metformin can be
started at 500 mg once or twice daily and increased to 1000mg twice daily after
1 week if tolerated. If side effects are persistent, the dose can be increased more
slowly. The maximum dose is 2550mg daily.
Victoza is not insulin. It is not known if Victoza is safe and effective when used with insulin. Victoza is not for people with type 1 diabetes or people with diabetic ketoacidosis.
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