Over the over the counter substitute for metformin counter alternative to metformin.
I recently wrote about the history of metformin, but I thought would review it in detail here. First of all, we should remember that metformin was developed in the mid-1960s and, therefore, is almost two decades old at the time of this article. In fact, its history dates back to 1965 Cost neurontin 300 mg when the patent for product was issued, at which point it was sold by Roche for more than a decade. Interestingly, the earliest reference to a treatment for type I diabetic patients with metformin (a.k.a. NIDDM) is from 1962 in the "Diabetes – British Prescription" article by John A. Stiles and James G. Siddle. After reading this article, a "Mendelian randomization study" was done to compare metformin, phenformin and rosiglitazone (another treatment for NIDDM) with a placebo, but it was not made public (until the publication of my article with Borenstein et al in the January 2007 issue of Diabetes Care, which is devoted to the treatment of NIDDM).
Over the years, however, FDA have Amlodipine besylate us fda made clear that metformin was safe and effective; these are in their official guidance documents (1,2). Thus from the outset, FDA have recognized benefits and demonstrated this through positive results on their own. In 2004, the FDA released results of a meta-analysis the efficacy metformin in "Type 1", 2", "non-insulin dependent diabetes mellitus", and "type 3" (3). Of note, these studies were not randomised, so the actual effect size could not be determined. The meta-analysis reported that metformin was associated with a reduction in fasting blood sugar levels (mean difference of 8.3 mg per deciliter) and increases in HDL cholesterol (3.6 mg per deciliter) with a combined statistical effect size (95% confidence interval, −5.1 to 16.3) that would be expected in a "pure" study (p=0.04). There were also no adverse events.
At the same time, however, meta-analysis reported that the risk of major complications during intensive diabetes treatment of patients treated with metformin and placebo was 20.8% 10.7% in the intensive and control groups, respectively. These risk estimates were not statistically significantly different, indicating that the risk of major adverse cardiac events was increased significantly (p=0.0001).
Two important reviews were finally conducted to compare the safety and efficacy of metformin its generic counterpart, a pheny-MCT. Cochrane systematic review of pheny-MCT for type 2 diabetes (4) was the first, published in European Journal of Clinical Nutrition in 2003 (5). The authors followed "usual search procedure" for clinical trials using a search of MEDLINE and EMBASE for randomized, controlled trials using pheny-MCT and found 5 studies evaluating the effect of pheny-MCT in children and adolescents with type 2 diabetes. These included two randomized clinical trials (RCTs) which compared phenylalanine-enriched pheny-MCT to placebo, and three cohort trials with more than 700 patients. The first RCT reported a mean reduction in HbA 1c by −0.25 mmol/mol at 4 months (1168 over the counter medicine like metformin patients), but no further reduction after 20 months (1187 patients). The other Prozac order online RCT reported a decrease in HbA 1c by −0.