An Update to the Article “Efficacy and Side Effect Profile of Different Formulations of Metformin: A Systematic Review and Meta-Analysis”

Abstract

Why carry out this study?Despite the very widespread clinical use of metformin, there is a lack of systematic evidence to guide optimal selection of the various formulations available. What was learned from the study?Updated data have now become available to add to our systematic review and metaanalysis.Incorporation of these new data does not substantively alter the conclusions of our meta-analysis.We showed that long-acting metformin formulations have equal efficacy in glycaemic control compared to immediate-release metformin, with additional benefits of reduced low-density lipoprotein cholesterol concentrations with extended-release metformin and reduced gastrointestinal side effects with delayed-release metformin. This Editorial is based on a previous published article (Tarry-Adkins JL et al. Efficacy and Side Effect Profile of Different Formulations of Metformin: A Systematic Review and Meta-Analysis. Diabetes Ther. 2021

Gastrointestinal adverse events of metformin treatment in patients with type 2 diabetes mellitus: A systematic review, meta-analysis and meta-regression of randomized controlled trials

“…We show that the type of formulation used had a significant meaning in case of bloating and diarrhea where treatment with metformin IR was associated with a higher risk of certain GI AEs. The latter finding is reflected in the previous metanalysis showing that metformin XR compared to metformin IR is associated with a reduction of GI adverse side effects, but did not reach the pre-specified threshold for statistical significance (18). On the other hand, Frontiers in Endocrinology frontiersin.org there was similar effectiveness and safety of metformin XR and IR, suggesting that it might not be appropriate to switch from metformin IR to metformin XR for improving glucose control or reducing AEs (19).…”

“…Despite the very widespread clinical use of metformin, there is a lack of systematic evidence regarding the risk of GI AEs of the drug compared to other glucose-lowering drugs or placebo with the exception of recent meta-analyses comparing different metformin formulations (18)(19)(20) and network meta-analyses that focused mainly on drugs other than metformin (21,22). Our aim was to assess the risk of GI AEs of metformin treatment in T2DM patients through performing a systematic review and meta-analysis with meta-regression of randomized controlled trials (RCTs).…”

Novel pH-sensitive gum ghatti-cl-poly(acrylic acid) composite hydrogel based on graphene oxide for metformin hydrochloride and sodium diclofenac combined drug-delivery systems

“…In terms of glycemic control, the results show that the longer-acting extended-release (XR) and delayed-release (DR) metformin formulations were as effective as immediate-release (IR) formulations, but the longer-acting formulations offer significant advantages. 69 Metformin XR was linked to lower serum LDL cholesterol levels, whereas metformin DR was strongly linked to lower GI side effects, which may improve drug adherence. More research is needed to fine-tune the optimal cost-benefit ratio of the various metformin preparations available in different clinical settings.…”