Introduction
Many diseases are treated with specific medications, but the advantages and great results are not evident to some healthcare providers. This is a major shortcoming of evidence-based healthcare practice, and the information must be spread as soon as possible so that medics begin to treat their patients with useful medications. In addition, healthcare specialists may start to doubt that a particular treatment for a disease, which has been the first line for many years, is still the best solution. The same is now happening with metformin as the primary treatment for type 2 diabetes. Therefore, the clinical practice question is the following: How does the use of metformin help in the treatment and prognosis of diabetes mellitus?
The Context of the Question
To begin with, it is essential to discuss the context and background of the research question. As noticed by Baker et al. (2021), “metformin is a biguanide that is used as first-line treatment of type 2 diabetes mellitus and is effective as monotherapy and in combination with other glucose-lowering medications” (p. 1). This medication has minimal side effects, is highly safe, and may be afforded by most patients due to its low cost.
Thanks to the great results of this medication, metformin has been considered the primary treatment for type 2 diabetes and used to address some other diseases, including liver diseases, cancers, obesity, and renal diseases. Nevertheless, modern healthcare researchers and practitioners begin to doubt whether metformin is the best choice (Baker et al., 2021). The reason is that some other antihyperglycemic medications may provide patients with more advantageous effects (Lv & Guo, 2020). What is more, even though metformin has been successfully used for more than sixty years (Lv & Guo, 2020), the cardiovascular outcomes data are limited for this medication. According to researchers, “the available studies fail to provide strong evidence due to either small sample size or short duration” (Baker et al., 2021, p. 1). This is why there is a clinical question that needs to be addressed to improve treatment outcomes.
The Evidence-Based Information Related to the Question
Metformin is considered valuable due to its low costs and remarkable effect of decreasing plasma glucose levels. After decades of choosing metformin as the main treatment for diabetes patients, it was possible to determine other ways to use it. Synthesized in the 1920s, metformin appeared to be one of the most effective solutions for treating type 2 diabetes patients. As noticed by Lv and Guo (2020), “metformin is a rational treatment choice for pregnant women with T2D, gestational diabetes, and the polycystic ovarian syndrome” (p. 2). Though this medication is already quite effective, sometimes it is better to use it in combination with other drugs, namely, glibenclamide, insulin, or troglitazone. For example, in combination with troglitazone, metformin leads to a higher reduction in postprandial glucose and fasting plasma glucose levels (Lv & Guo, 2020). However, during monotherapy, metformin is also very effective.
Further, it is essential to discuss metformin’s mechanism of action. Overall, “it inhibits hepatic gluconeogenesis, reduces the absorption of glucose from the intestines, and increases glucose uptake by tissue” (Baker et al., 2021, p. 2). It reduces the production of liver glucose, increases GLUT4-mediated glucose uptake in skeletal muscles, and stimulates GLP-1 release (Aroda & Ratner, 2018). When compared with other medications, metformin appears to show intermediate effects, but since it is cheaper and has fewer side effects, it is the preferred treatment.
Additionally, there are specific care guidelines explaining the management of hyperglycemia in diabetics, and these guidelines are provided by the American Diabetes Association. In 2008, it was stated that precisely metformin was the first-line therapy for people with type 2 diabetes. Although the recent years were characterized by debates regarding the effectiveness of metformin, in 2020, it was again stated that this medication remained the primary one “unless contraindicated or not tolerated by the patient” (Baker et al., 2021, p. 7). Therefore, these care guidelines support the effectiveness of metformin and recognize it as the best available option.
Overall, to determine the real essence of metformin and answer the research question, as well as understand whether it should remain the primary choice for people with diabetes, it is necessary to explore other benefits of this medication. For example, according to Aroda and Ratner (2018), during a randomized clinical trial, metformin therapy decreased the progression to diabetes by thirty-one percent. In cases with young patients or people with obesity, gestational diabetes, or higher fasting glucose, the effects of metformin were more evident and stronger than the effects of lifestyle intervention.
Incorporation Into Practice
From the evidence-based information provided above, one may learn about the high importance and usefulness of metformin in treating not only diabetes but several other diseases. Although some other drugs are also effective and may have more advantages in specific cases, metformin remains a recommended and primary choice for patients who tolerate it. Further evidence-based research is needed, and healthcare researchers must get more data and information. However, metformin should be used routinely in medicine to improve outcomes and reduce the level of type 2 diabetes among patients. It is highly expected from nurses to educate patients about this medication and its possible, though rather rare side effects. Nurses also need to talk to providers about its use and do their best to make sure that low-income patients receive the necessary dosage of metformin and experience its positive effects.
Fellow Students
It is evident now that this is a highly important question that needs to receive increased attention from healthcare professionals. Nurses and nursing students should understand the usefulness and benefits of metformin in preventing and treating type 2 diabetes at the early stages. As mentioned above, the main advantages of this medication include its low cost, minimal side effects, and high safety, which is why the information about metformin should be spread to healthcare professionals and students.
One may find that the evidence found for this research paper can be relayed to other students with the help of engaging and informative presentations to help them understand the importance of the use of metformin. Data comparison and analysis of how this medication helps reduce real-life rates of diabetes should help prove the importance of the issue. Further, when a group of students becomes interested in the topic, they can conduct more serious and extended research, gather data and statistics, and explore the background of the question to then spread the results among their peers.
References
Aroda, V. R., & Ratner, R. E. (2018). Metformin and type 2 diabetes prevention. Diabetes Spectrum, 31(4), 336–342. Web.
Baker, C., Retzik-Stahr, C., Singh, V., Plomondon, R., Anderson, V., & Rasouli, N. (2021). Should metformin remain the first-line therapy for treatment of type 2 diabetes?. Therapeutic Advances in Endocrinology and Metabolism, 12, 1-13. Web.
Lv, Z., & Guo, Y. (2020). Metformin and its benefits for various diseases. Frontiers in Endocrinology, 11(191), 1-10. Web.