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La metformina, la única biguanida actualmente comercializada, es más que un hipoglucemiante oral, un fármaco glucorregulador. Los aspectos moleculares de su mecanismo de acción no se conocen completamente, pero su acción fundamental se basa en el incremento de la sensibilidad hepática a la insulina y la facilitación del transporte de glucosa en situaciones de hiperglucemia y resistencia a la insulina. En la actualidad, se considera el fármaco de elección en el tratamiento inicial en pacientes con diabetes mellitus tipo 2, con y sin exceso de peso. Su utilización en tratamiento combinado con antidiabéticos orales (sulfonilureas, meglitinidas, glitazonas, inhibidores de las alfaglucosidasas) e insulina mejora su perfil terapéutico. Su efecto positivo en el control de la glucemia se ve complementado en su uso clínico por otras acciones, y evita la ganancia de peso corporal, y la mejoría de perfil lipídico y de riesgo cardiometabólico. La metformina ha demostrado eficacia en estudios de prevención de diabetes mellitus y en otras indicaciones asociadas a la resistencia a la insulina.
Palabras clave:
Metformina
Diabetes mellitus tipo 2
Insulinorresistencia
Biguanidas
Metformin, the only biguanide currently available commercially, is more than an oral hypoglycemic agent, it is also a glycoregulatory drug. The molecular features of its mechanism of action are not well defined, but its main action is based on an increase of insulin sensitivity in the liver and on facilitating glucose transport in situations of hyperglycemia and insulin resistance. Metformin is currently the initial drug of choice in patients with type 2 diabetes mellitus with and without excess weight. Its use in combination with oral antidiabetic agents (sulfonylureas, meglitinides, glitazones, alpha-glucosidase inhibitors) and insulin improve its therapeutic profile. Clinically, its positive effect on glycemic control is complemented by other actions such as avoidance of weight gain and improvement of lipid and cardiometabolic risk. The efficacy of metformin has been demonstrated in studies of diabetes mellitus prevention and other indications associated with insulin resistance.
Key words:
Metformin
Type 2 diabetes mellitus
Insulin resistance
Biguanides
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