PubMed · 631459
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M Nattrass, K G Alberti. 1978. Biguanides.. https://doi.org/10.1007/bf01263443
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BACKGROUND AND OBJECTIVES: Biguanides have been used in treatment of diabetes mellitus for over 30 years now. Due to frequent occurrence of lactic acidosis, particularly in patients with serious contraindications to biguanide therapy and in cases of non-compliance with dosage instructions, buformin and phenformin were taken off the market in most European countries at the end of the seventies. Metformin continued to be allowed, since the risk of lactic acidosis is 20 times less than with phenformin or buformin due to the different pharmacokinetic properties of the substance. Plenty of clinical experience has been gained with metformin, documented in a large number of reliable long-term studies. FINDINGS: Metformin lowers fasting blood glucose levels by an average of 25% (17 to 37%), postprandial blood glucose by up to 44.5% and HbA1c bei 1.5% (0.8 to 3.1%) Metformin reduces raised plasma insulin levels in cases of metabolic syndrome by as much as 30% and reduces the "insulin requirement" of type 2 insulin-treated diabetics by 15 to 32%. It has well documented effects on various rheological parameters. In overweight type 2 diabetics, metformin shows the same level of hypoglycaemic effect as all of the important sulfonylurea derivatives used in Europe. The active mechanism of these derivatives is, however, concentrated solely on reduction of blood glucose. This mechanism does not take into account the remaining risk constellation involved in insulin resistance. Biguanides, similarly to weight reduction, lead to a reduction of hyperinsulinaemia, which is by contrast exacerbated by sulfonylureas and, in particular, exogenous insulin. CONCLUSION: The risk of lactic acidosis can probably be eliminated entirely if dosage instructions and contraindications are observed carefully. The cause of such neglect in 83% of all cases was limited on renal function (serum creatinine > 1.5 mg%). Regarding morbidity and mortality from lactic acidosis, metformin therapy is no riskier than treatment with the sulfonylurea derivative glibenclamide, taking into account the incidence of fatal hypoglycaemias with the latter.
PURPOSE: The purpose of this study was to evaluate the effect of lens storage on the bactericidal activities of disinfecting solutions. METHODS: HYDROCURVEII (55% water content) soft contact lenses were soaked in OPTI-FREE Rinsing, Disinfecting, and Storage Solution (preserved with polyquaternium-1 [PQ-1]) or ReNu Multi-Purpose Solution (polyaminopropyl biguanide [PHMB]). After the lenses were removed, solutions were challenged with Pseudomonas aeruginosa and Staphylococcus aureus. Uptake of the antimicrobial agents by the lenses was evaluated by placing the lenses on plates seeded with S. aureus and observing for zones of growth inhibition. RESULTS: The bactericidal activity of the PHMB preserved solution decreased after 4 hours of storage time and showed no activity after storage for 3 days. Lenses soaked in the PHMB preserved solution produced zones of inhibition. The results suggest that the PHMB in the solution accumulates in the lens. This decreases the levels of preservative in the solution that is no longer available during lens storage. Neither decrease in bactericidal activity nor accumulation of the PQ-1 preservative in the lens occurred during storage with the PQ-1 solution. CONCLUSION: These results demonstrate that PQ-1 preserved solutions maintain bactericidal activity overnight and during prolonged storage without detectable uptake by lenses.