Biguanides

Biguanides are a class of medicinal compounds primarily used in the treatment of type 2 diabetes. The most well-known biguanide is metformin, which is commonly prescribed to manage blood glucose levels in patients with type 2 diabetes. This article provides an overview of biguanides, their mechanism of action, clinical uses, and associated side effects.

History

Biguanides were first derived from the French lilac or goat's rue (Galega officinalis), a plant known for its antidiabetic properties. The use of this plant in traditional medicine dates back to medieval times. The modern therapeutic form, metformin, was developed from the natural compounds found in this plant.

Mechanism of Action

Biguanides work primarily by reducing the production of glucose in the liver, a process known as gluconeogenesis. They also increase the sensitivity of muscle cells to insulin, facilitating the uptake of glucose, and slightly reduce the absorption of glucose from the gut. These actions collectively help to lower blood sugar levels and improve glycemic control in diabetic patients.

Clinical Uses

The primary use of biguanides is in the management of type 2 diabetes, particularly in individuals who are overweight or obese, as it does not tend to cause weight gain—a common side effect of other diabetes medications. Additionally, biguanides have been investigated for their potential benefits in conditions such as polycystic ovary syndrome (PCOS), non-alcoholic fatty liver disease, and even as an adjunct therapy in cancer treatment.

Side Effects

While biguanides are generally well-tolerated, they can cause some side effects. The most common is gastrointestinal upset, including diarrhea, nausea, and abdominal discomfort. A more serious but rare side effect is lactic acidosis, a condition characterized by the buildup of lactic acid in the body, which can be life-threatening if not treated promptly.

Future Directions

Research continues into the broader applications of biguanides, particularly their potential anti-aging and anti-cancer effects. Studies are exploring mechanisms beyond glucose control, such as their impact on cellular metabolism and inflammation.

See Also

• Insulin
• Diabetes mellitus
• Pharmacology