El fármaco de elección en diabetes actual sin mucha evidencia en cuanto a mortalidad cardiovascular y total. Todo este mito de la "cura química" está haciendo mucho daño a la salud de la gente, porque dejan su salud en manos de un fármaco bajo la creencia inducida por la publicidad biosanitaria de su poder terapéutico, y entonces no hace otras cosas que sí son terapéuticas. Es decir, los fármacos, y la medicina actual, desplazan otras terapias que sí son efectivas como ejercicio y nutrición, y fomentan hábitos poco saludables y consumo de fármacos en su mayoría sin evidencia de eficacia excepto surrogates, aún menos de efectividad.
http://ebm.bmj.com/content/18/2/e13.extractMetformin may not reduce cardiovascular risk or all-cause mortality
The treatment of hyperglycaemia is considered as one of the tools for preventing cardiovascular disease in Type 1 and Type 2 diabetic (T2D) patients.1 ,2 Metformin is recommended as the first-line drug for T2D by most international guidelines (IDF.2005. http://www.idf.org, 2007. http://www.aace.com, http://www.diabetesjournals.org, http://www.nice.org.uk/CG66). The preference for metformin over other available drugs is based on its efficacy on blood glucose control, tolerability, safety and low cost (IDF.2005. http://www.idf.org, 2007. http://www.aace.com, http://www.diabetesjournals.org, http://www.nice.org.uk/CG66). Metformin seems to have a favourable profile of action on several extraglycaemic risk factors, including lipids, …
http://www.plosmedicine.org/article/inf ... ed.1001204The UK Prospective Diabetes Study showed that metformin decreases mortality compared to diet alone in overweight patients with type 2 diabetes mellitus. Since then, it has been the first-line treatment in overweight patients with type 2 diabetes. However, metformin-sulphonylurea bitherapy may increase mortality.
Methods and Findings
This meta-analysis of randomised controlled trials evaluated metformin efficacy (in studies of metformin versus diet alone, versus placebo, and versus no treatment; metformin as an add-on therapy; and metformin withdrawal) against cardiovascular morbidity or mortality in patients with type 2 diabetes. We searched Medline, Embase, and the Cochrane database. Primary end points were all-cause mortality and cardiovascular death. Secondary end points included all myocardial infarctions, all strokes, congestive heart failure, peripheral vascular disease, leg amputations, and microvascular complications. Thirteen randomised controlled trials (13,110 patients) were retrieved; 9,560 patients were given metformin, and 3,550 patients were given conventional treatment or placebo. Metformin did not significantly affect the primary outcomes all-cause mortality, risk ratio (RR) = 0.99 (95% CI: 0.75 to 1.31), and cardiovascular mortality, RR = 1.05 (95% CI: 0.67 to 1.64). The secondary outcomes were also unaffected by metformin treatment: all myocardial infarctions, RR = 0.90 (95% CI: 0.74 to 1.09); all strokes, RR = 0.76 (95% CI: 0.51 to 1.14); heart failure, RR = 1.03 (95% CI: 0.67 to 1.59); peripheral vascular disease, RR = 0.90 (95% CI: 0.46 to 1.78); leg amputations, RR = 1.04 (95% CI: 0.44 to 2.44); and microvascular complications, RR = 0.83 (95% CI: 0.59 to 1.17). For all-cause mortality and cardiovascular mortality, there was significant heterogeneity when including the UK Prospective Diabetes Study subgroups (I2 = 41% and 59%). There was significant interaction with sulphonylurea as a concomitant treatment for myocardial infarction (p = 0.10 and 0.02, respectively).
Although metformin is considered the gold standard, its benefit/risk ratio remains uncertain. We cannot exclude a 25% reduction or a 31% increase in all-cause mortality. We cannot exclude a 33% reduction or a 64% increase in cardiovascular mortality. Further studies are needed to clarify this situation.