The molecular pathology at Work: Metformin and Variability in Glycemic Control

Abstract

Optimized management of type-2 diabetes mellitus (T2DM) remains a challenge not just because micro and microangiopathies’, chronic kidney disease, and infections related to poor cellular immunity. Methodology to manage T2DM remains in need for evolution to curb disease and help manage economy of diabetes care. Metformin remains the frontline soldier against T2DM. However, optimized and evidence-based use of metform for managing T2DM in clinics needs better molecular analytics to micro-precise medical management. We evaluated 353 manuscripts to finally shortlisted 45 reviews and RCTs using PRISMA guidelines from Google Scholar, PubMed and Cochrane Reviews. This systematic review attempted to identify the role of pharmacokinetic, pharmacogenomic, epigenetic and mitochondrial factors which can lead to sub-optimal diabetes management, metformin resistance and mutations which could lead to poor to no response to medicine. The most common mutations and polymorphisms in solute channels were observed to reduce the therapeutic efficacy/resistance

Keywords

• Metformin
• Metformin resistance
• metformin response variability
• pharmacokinetics of metformin
• pharma-cogenetics of metformin
• Type 2 Diabetes Mellitus