Dr. McPhee: Excellent choice! Metformin is the most appropriate drug for Mr. Green, who has no signs of kidney or hepatic dysfunction and no compelling co-morbidity to indicate that one of the newer, more expensive medications, is indicated. Metformin can be useful in overweight patients. Additionally, it has cardiovascular benefits, which are important given Mr. Green’s history of hypertension.  

In addition to prescribing metformin, Dr McPhee explains that they need to monitor his blood pressure to ensure continued control and gives Mr. Green lifestyle advice, as it forms an important part of management of his type 2 diabetes. Mr. Green admits that he has received similar advice in the past but he finds it difficult to comply with these recommendations. Dr. McPhee explains that metformin may also help in reducing weight.

Which pharmacological effect is most likely to occur with metformin in diabetic patients like Mr. Green?