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Their primary mechanisms of action include: Enhancing glucose-dependent insulin secretion from pancreatic beta cells Suppressing glucagon release , thereby reducing hepatic glucose production Slowing gastric emptying , which moderates post-meal glucose spikes Reducing appetite through central nervous system effects, particularly in hypothalamic regions Promoting satiety , leading to reduced caloric intake These medications have demonstrated significant benefits in glycaemic control, weight reduction, and cardiovascular risk reduction in clinical trials

This article examines the evidence, explores possible mechanisms, and provides practical guidance for patients and healthcare providers

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Additional but rare side effects include: low blood sugar (hypoglycemia) feeling cold unusual muscle pain dizziness slow or irregular heart rate trouble breathing metallic taste changes to nails on fingers and toes Low b12 levels DRUG INTERACTIONS As with other medications, metformin can interact with alcohol and certain medications, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, corticosteroids, hormone replacement therapy and estrogens, oral contraceptives, carbonic anhydrase inhibitors, nifedipine, thiazides or furosemide and other diuretics, phenothiazines, phenytoin, nicotinic acid (niacin), multidrug and toxin extrusion inhibitors, sympathomimetics, calcium channel blockers, isoniazid (antibiotic for tuberculosis), insulin and glyburide or other medications for diabetes, and medications for thyroid disease