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Is Metformin Used To Treat Prediabetes?

Information About This Medicine

Information About This Medicine

What are the most important things you need to know about your medicines? Make sure you know about each of the medicines you take. This includes why you take it, how to take it, what you can expect while you're taking it, and any warnings about the medicine. The information provided here is general. So be sure to read the information that came with your medicine. If you have any questions or concerns, talk to your pharmacist or doctor. Why is metformin used? Metformin is a medicine used to treat prediabetes, type 2 diabetes, and gestational diabetes. It helps control your blood sugar. It is also used to treat polycystic ovarian syndrome. Metformin works very well and is generally safe. What are some examples of metformin? Here are some examples of metformin. For each item in the list, the generic name is first, followed by any brand names. metformin (Glucophage) long-acting metformin (Glucophage XR, Glumetza, Fortamet) liquid metformin (Riomet) Sometimes metformin is combined with other diabetes medicine. Avandamet is a combination of metformin and rosiglitazone. Glucovance is a combination of metformin and glyburide. Janumet is a combination of metformin and sitagliptin. This is not a complete list. What about side effects? When they first start taking metformin or start taking a larger dose, some people feel sick to their stomach or have diarrhea for a short time. Over time, blood levels of vitamin B12 can decrease in some people who take metformin. Your body needs this B vitamin to make blood cells and to keep your nervous system healthy. If you have been taking metformin for more than a few years, ask your doctor if you need a B12 blood test to measure the amount of vitamin B12 in your blood. General information on side effects All medicines can cause side effects. Continue reading >>

Pre-diabetes Prescription Drugs

Pre-diabetes Prescription Drugs

Click here for the Health Tip link. Q: My doctor told me I need to take drugs for something he calls pre-diabetes. After reading your tips on the pharmaceutical industry, can you give me any advice on whether or not I need to take them? A That’s a great question because it exemplifies how doctors let themselves off the hook by reaching for a prescription pad. Generally, most pre-diabetics are overweight and maybe diabetes runs in the family. You carry your weight in your midsection. Your primary exercise is lifting a fork and you do like your refined “white” carbohydrates. Here’s what happens: Whenever we eat, our blood sugar (glucose) rises and in order to move the glucose molecule into our cells, where it’s used for energy, the pancreas, a gland safely tucked behind your intestines, produces the hormone insulin. In pre-diabetes, this entire response system becomes fatigued. The cells receiving glucose become resistant to the insulin (insulin resistance) and the pancreas responds by going into overdrive and producing more insulin (hyperinsulinemia). In time, the system finally breaks down, blood sugar starts to rise, and the “pre-diabetes” of hyperinsulinism and insulin resistance changes to diabetes, which is high blood sugar. The prescription drug for pre-diabetes is metformin, which works by reducing insulin resistance. Later, when you develop diabetes, a second drug is added that literally flogs your pancreas to make more insulin. When the action of these two meds starts to fail (you can only flog so much before the system collapses altogether), your doctor gives up and you start taking injections of synthetic insulin. Pre-diabetes is considered a risk not only because it can lead to diabetes but also because it increases your risk of developing heart Continue reading >>

Drug That Can Prevent The Onset Of Diabetes Is Rarely Used

Drug That Can Prevent The Onset Of Diabetes Is Rarely Used

Few doctors are prescribing a low-cost drug that has been proven effective in preventing the onset of diabetes, according to a UCLA study. The study, published in the peer-reviewed journal Annals of Internal Medicine, found that only 3.7 percent of U.S. adults with pre-diabetes were prescribed metformin during a recent three-year period. Metformin and lifestyle changes both can prevent the onset of diabetes, but people often struggle to adopt healthier habits, according to Dr. Tannaz Moin, the study’s lead author and an assistant professor of medicine in the division of endocrinology at the David Geffen School of Medicine at UCLA and at VA Greater Los Angeles. “Diabetes is prevalent, but pre-diabetes is even more prevalent and we have evidence-based therapies like metformin that are very safe and that work,” Moin said. “Metformin is rarely being used for diabetes prevention among people at risk for developing it. This is something that patients and doctors need to be talking about and thinking about.” It is estimated that about one-third of adults in the U.S. have pre-diabetes, which is marked by higher-than-normal blood sugar levels. The American Diabetes Association in 2008 added metformin to its annual “Standards for Medical Care in Diabetes” guidelines for use in diabetes prevention for those at very high risk who are under age 60, are severely obese, or have a history of gestational diabetes. Under the guidelines, metformin may also be considered for patients whose blood sugar is above normal but not yet in the diabetes range. The researchers examined data from 2010 to 2012 from UnitedHealthcare, the nation’s largest private insurer, for a national sample of 17,352 adults aged 19 to 58 with pre-diabetes. They also found: The prevalence of metformin Continue reading >>

Diagnosis

Diagnosis

Print The American Diabetes Association (ADA) recommends that blood glucose screening for adults begin at age 45, or sooner if you are overweight and have additional risk factors for prediabetes or type 2 diabetes. There are several blood tests for prediabetes. Glycated hemoglobin (A1C) test This test indicates your average blood sugar level for the past two to three months. Specifically, the test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. In general: An A1C level below 5.7 percent is considered normal An A1C level between 5.7 and 6.4 percent is considered prediabetes An A1C level of 6.5 percent or higher on two separate tests indicates type 2 diabetes Certain conditions can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin (hemoglobin variant). Fasting blood sugar test A blood sample is taken after you fast for at least eight hours or overnight. In general: A fasting blood sugar level below 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is considered normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L) is considered prediabetes. This result is sometimes called impaired fasting glucose. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 2 diabetes. Oral glucose tolerance test This test is usually used to diagnose diabetes only during pregnancy. A blood sample is taken after you fast for at least eight hours or overnight. Then you'll drink a sugary solution, and your blood sugar level will be measured again after two hours. In general: A blood sugar level less than 140 mg/dL (7.8 mmo Continue reading >>

Can Metformin Help With Weight Loss?

Can Metformin Help With Weight Loss?

Metformin is a drug prescribed to manage blood sugar levels in people with type 2 diabetes. You may have heard that metformin can also help you lose weight. But is it true? The answer is a resounding maybe. Here’s what you should know about what metformin can do for weight loss, as well as why your doctor may prescribe it for you. According to research, metformin can help some people lose weight. However, it’s not clear why metformin may cause weight loss. One theory is that it may prompt you to eat less by reducing your appetite. It may also change the way your body uses and stores fat. Although studies have shown that metformin may help with weight loss, the drug is not a quick-fix solution. According to one long-term study, the weight loss from metformin tends to occur gradually over one to two years. The amount of weight lost also varies from person to person. In the study, the average amount of weight lost after two or more years was four to seven pounds. Taking the drug without following other healthy habits may not lead to weight loss. Individuals who follow a healthy diet and exercise while taking metformin tend to lose the most weight. This may be because metformin is thought to boost how many calories you burn during exercise. If you don’t exercise, you likely won’t have this benefit. In addition, any weight loss you have may only last as long as you take the medication. That means if you stop taking metformin, there’s a good chance you will return to your original weight. And even while you’re still taking the drug, you may slowly gain back any weight you’ve lost. In other words, metformin may not be the magic diet pill some people have been waiting for. It has been shown to reduce weight in some, but not others. One of the benefits of metformin Continue reading >>

Therapeutic Use Of Metformin In Prediabetes And Diabetes Prevention

Therapeutic Use Of Metformin In Prediabetes And Diabetes Prevention

Go to: Pathophysiology and Diagnosis of Prediabetes The defects in glucose metabolism that underlie type 2 diabetes begin many years before the diagnosis of diabetes is made [6, 7]. The development of insulin resistance, in which the action of insulin on glucose metabolism is blunted, occurs early in the pathogenesis of dysglycaemia. Increased secretion of insulin initially compensates for the presence of insulin resistance; however, a simultaneous and progressive loss of β-cell mass and β-cell function limits the ability of the pancreas to maintain euglycaemia by increasing insulin secretion [8]. The early manifestations of prediabetic dysglycaemia represent one or both of [9]: impaired glucose tolerance (IGT), in which postprandial glucose control is impaired but fasting plasma glucose (FPG) is normal; impaired fasting glucose (IFG), in which a chronic elevation of FPG occurs in the absence of a deterioration in postprandial glucose control. Table 1 shows the usually accepted diagnostic criteria for the diagnosis of prediabetes based on measurements of glycaemia [4, 8–10]. A simple blood test is sufficient to diagnose IFG, while a 75 g oral glucose tolerance test (OGTT) is required for the diagnosis of IGT. The originally used cutoff level for IFG (110 mg/dL [6.1 mmol/L]) was reduced to that shown in Table 1 (100 mg/dL [5.6 mmol/L]) by an Expert Committee of the American Diabetes Association in 2003, in order to equalise the prognostic impact of diagnosis of IFG or IGT, in terms of the future risk of diabetes in a subject with either condition [11]. It should be noted that the World Health Organization (WHO) diagnostic criteria for IFG retains the 110 mg/dL (6.1 mmol/L) cutoff value for diagnosing IFG [12]. Diagnostic criteria from the American Diabetes Associatio Continue reading >>

Treating Prediabetes With Metformin

Treating Prediabetes With Metformin

Go to: Abstract To determine if the use of metformin in people with prediabetes (impaired glucose tolerance or impaired fasting glucose) would prevent or delay the onset of frank type 2 diabetes mellitus. MEDLINE was searched from January 1966 to the present, and articles meeting the selection criteria were hand searched. Randomized controlled trials that involved administration of metformin to delay or prevent type 2 diabetes in individuals with impaired glucose tolerance or impaired fasting glucose were included. Development of diabetes was a required outcome measure; follow-up time of at least 6 months was required. Three studies met these criteria. The 3 studies varied in ethnicity of the population studied, in the rates of conversion to diabetes from prediabetes, and in the dose of metformin used. In general the studies were well done, although 2 of the 3 did not do true intention-to-treat analyses. A sensitivity analysis was completed by converting all data to intention-to-treat data and assuming a worst-case scenario for the people who were lost to follow-up. Metformin decreases the rate of conversion from prediabetes to diabetes. This was true at higher dosage (850 mg twice daily) and lower dosage (250 mg twice or 3 times daily); in people of varied ethnicity; and even when a sensitivity analysis was applied to the data. The number needed to treat was between 7 and 14 for treatment over a 3-year period. Summary of results from reviewed trials: Development of diabetes outcomes. STUDY OUTCOME EER n/N (%) CER n/N (%) RRR % (95% CI) ARR % (95% CI) NNT N (95% CI) YATES CORRECTED P VALUE COMMENTS Li et al,22 1999 (Primary analysis of 70 participants) Development of diabetes at 12 mo 1/33 (3.0) 6/37 (16.2) 81.3 (−9.5 to 97.0) 13.2 (−0.9 to 17.9) 7.6 (5.5 to infinit Continue reading >>

Metformin For Prediabetes: Success

Metformin For Prediabetes: Success

In a controlled trial, 600 overweight and obese people with prediabetes were given metformin. Metformin is in the biguanide class. It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues. It also can possibly help patients to lose weight, and possibly prevent some forms of cancer. Metformin was discovered in 1922. Study in humans began in the 1950s, by French physician Jean Sterne. It was introduced as a medication in France in 1957 and the United States in 1995. It is on the World Health Organization’s List of Essential Medicines, the most important medications needed in a basic healthcare system. Metformin is believed to be the most widely used medication for diabetes, which is taken by mouth. It is available as a generic medication. The wholesale price in In the United States costs $3 to $25 USD per month. For those patients who are under age 60 with prediabetes, the ADA has recommended metformin for those with a BMI over 34 and for women with gestational diabetes in the past. But, for others, especially for those over the age of 60, and even teenagers who rarely are treated with metformin, the study found that just 3.7% of those with prediabetes were actually prescribed metformin, over a 3-year period. Since metformin has been around since 1950 and even longer overseas and has even been shown to possibly prevent certain kinds of cancer, why should it not be standard procedure to provide all those with prediabetes the option to be treated with metformin? With the cost for the 29 million patients with diabetes at over 300 billion dollars, should we be asking the question: with more than 90 million people in the U.S. with prediabetes — a number that’s still growing — why doesn’t the FDA or the ADA recommen Continue reading >>

Metastudy Confirms Metformin Appropriate Treatment For Prediabetes

Metastudy Confirms Metformin Appropriate Treatment For Prediabetes

A study that reviewed several previous studies about the impact of using metformin on the progression of prediabetes to diabetes confirms that yes, people with prediabtes who take metformin end up with better blood sugars after 3 years than those who don't and are therefore less likely to be diagnosed with full-blown diabetes. This isn't original research, it's just a look at the major studies that have examined the impact of metformin on prediabetes. But because I hear from so many people with prediabetes whose doctors won't give them any help at all, I though it worth a look. Treating prediabetes with metformin: Systematic review and meta-analysis Muriel Lilly, Can Fam Physician Vol. 55, No. 4, April 2009, pp.363 - 369 The key issue to remember here is that the concept that "prediabetes" progresses to "diabetes" which treats the two conditions as if they were separate diseases is flawed. In fact, the medical definition of "diabetes" is completely arbitrary. A committee years ago chose some blood sugar test results and defined them as "diabetes." They could have--and many argue should have--chosen different test result numbers. But they chose the ones they did mainly, their own documentation showed, to diagnose people with diabetes as late as possible, because of the severe penalties the American medical system imposes on people who have pre-existing conditions. You can read about how the diagnostic standards for diabetes were set HERE. "Prediabetes" was also defined arbitrarily at the same time as "diabetes" was defined and as has been the case with diabetes, the definition has changed over the years. But what you, the person with abnormal blood sugar, need to understand is that there's no sudden change in your health that happens when you get an official diabetes dia Continue reading >>

Insulin Resistance And The Use Of Metformin: Effects On Body Weight

Insulin Resistance And The Use Of Metformin: Effects On Body Weight

by Ruchi Mathur, MD, FRCPC Dr. Mathur is Assistant Professor of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, California. Bariatric Times. 2011;8(1):10–12 Abstract Metformin is a widely perscribed drug for the treatment of diabetes and is often used off label for the treatment of prediabetes and insulin resistance. In addition to its primary use, metformin has often been cited as having weight loss benefits. This article reviews the concept of insulin resistance as it pertains to body weight and the effects of meformin on body weight in subgroups of patients with and without diabetes. Introduction Insulin is an anabolic storage hormone produced by the beta cells in both a basal and a pulsatile fashion in response to food intake. Insulin is fundamental in allowing cells to uptake and use glucose. Insulin also regulates gluconeogenesis along with processes, such as protein synthesis and lipogenesis. When we were evolving, the theory is that insulin was necessary because we lived a life of feast and famine. Those who could store calories had a survival benefit, thus insulin had a significant evolutionary role. So, where and when did insulin become a bad thing? Likely, at the same time our evolutionary environment took a bit of a turn. These days, it is usual to go three hours without eating, and certainly not three days! Thus, what was once adaptive is now maladaptive as we continue to store as our ancestors did. Our environment has changed faster than our genetics. Insulin resistance is an impaired response to endogenous or exogenous insulin in cells, tissues (especially skeletal muscle and adipose tissue), the liver, or the whole body.[1,2] Many investigators believe that insulin resistance is an important factor in the development of th Continue reading >>

Take Metformin If You Have Prediabetes

Take Metformin If You Have Prediabetes

Do you have prediabetes? You might be able to ward it off with the help of one of the diabetes drugs. Metformin might stop you from getting diabetes and could also help you in other ways. But persuading your doctor to prescribe it could be a challenge. The biggest and perhaps the best study of people who have prediabetes showed that taking metformin cuts the risk of diabetes by 31 percent. While this was less than the reduction of 58 percent that the “lifestyle intervention” provided, in real life we usually aren’t able to get that much guidance from our medical team. By “lifestyle intervention” the researchers meant being in a program that provided information, guidance, and support to help participants lose 7 percent or more of their weight and to get moderately intense physical activity — like brisk walking — for at least 150 minutes a week. But without that guidance, it typically takes a long time to help, and in fact it most people just don’t do it. Who Metformin Helps Most The study showed that metformin helped the most among younger people, and with people who had a high body mass index (BMI) or a high fasting blood glucose level. It doesn’t help seniors much. But the biggest problem with metformin is to have your doctor prescribe it. Only 3.7 percent of insured adults who had a prediabetes diagnosis were taking it between 2010 and 2012, according to a study that the Annals of Internal Medicine published last year. This very low proportion is probably because the U.S. Food and Drug Administration hasn’t approved metformin — or any other drug — for prediabetes. While doctors are free to prescribe it “off label,” some of them are hesitant to do that. Some Side Effects Like any drugs, metformin sometimes has unwanted side effects. The mos Continue reading >>

Utilizing Medication (prediabetes)

Utilizing Medication (prediabetes)

A number of medications are available right now to treat and perhaps reverse prediabetes. Useful medications should have the following characteristics: They should not cause weight gain. They should (we hope) cause weight loss. They should be easy to take. They should not have significant side effects that make the medications worse than the problems they are treating. Several medications fulfill these criteria, and they are the subject of the next few pages. Your doctor must decide whether to provide you with these medications, but you need to be an informed consumer. You may even be the one who instigates the use of medication because many doctors are not yet fully tuned in to the concerns of prediabetes. Starting with metformin All drug treatment for prediabetes should probably start with metformin until and unless something better comes along. Since 1995, metformin has been approved in the United States for the treatment of diabetes. While metformin is relatively new to the U.S. market, it has a longer history than the previous paragraph implies. A similar medication called phenformin had been banned in the United States because it caused a fatal complication called lactic acidosis (a condition where the blood becomes very acidic). As a result, the U.S. Food and Drug Administration (FDA) was reluctant to okay metformin until clinical studies proved it to be safe, even though it had been used for years in Europe with no problems. How safe is metformin? In a July 2009 study published in Critical Care Medicine, people given an experimental overdose of metformin suffered no negative consequences. The only threat is to patients who already have multiple organ failure; if they are accidentally given an overdose of metformin, they may develop lactic acidosis and die. For e Continue reading >>

Pre-diabetes

Pre-diabetes

What Is It? In pre-diabetes, blood sugar levels are slightly higher than normal, but still not as high as in diabetes. If diabetes is "runaway blood sugar" think of pre-diabetes as blood sugar that is "halfway out the door." People almost always develop pre-diabetes before they get type 2 diabetes. The rise in blood sugar levels that is seen in pre-diabetes starts when the body begins to develop a problem called "insulin resistance." Insulin is an important hormone that helps you to process glucose (blood sugar). If usual amounts of insulin can't trigger the body to move glucose out of the bloodstream and into your cells, then you have insulin resistance. Once insulin resistance begins, it can worsen over time. When you have pre-diabetes, you make extra insulin to keep your sugar levels near to normal. Insulin resistance can worsen as you age, and it worsens with weight gain. If your insulin resistance progresses, eventually you can't compensate well enough by making extra insulin. When this occurs, your sugar levels will increase, and you will have diabetes. Depending on what a blood sugar test finds, pre-diabetes can be more specifically called "impaired glucose (sugar) tolerance" or "impaired fasting glucose." Impaired fasting glucose means that blood sugar increase after you haven't eaten for a while – for example, in the morning, before breakfast. Impaired glucose tolerance means that blood sugar levels reach a surprisingly high level after you eat sugar. To diagnose impaired glucose tolerance, doctors usually use what is called a "glucose tolerance test." For this test you drink a sugary solution, and then you have blood drawn after a short time. Having pre-diabetes does not automatically mean you will get diabetes, but it does put you at an increased risk. Pre- Continue reading >>

Are There Any Medications For Prediabetes?

Are There Any Medications For Prediabetes?

Yes. No. Kinda. OK, here’s the deal, the FDA hasn’t actually approved any medications for prediabetes, but doctors commonly prescribe two classes of medications “off label” to help treat the condition. The first class are thiazolidinediones, conveniently called TZDs, such as Actos. These are basically anti-insulin resistance medications. As prediabetes is a growing problem of insulin resistance, a medication to fight insulin resistance is a logical fit to try and prevent what we call conversion—that is moving from prediabetes to full-blown diabetes. The thought is that by reducing insulin resistance you can reduce overwork on the part of the pancreas (which is working overtime to try and overwhelm the insulin resistance) and thus delay the “burnout” of the pancreas that causes diabetes. The other class of drugs that seem to help are biguanides, such as Metformin. Met has a small effect on insulin resistance but for the most part attacks another part of the prediabetes equation which is the liver’s tendency to over produce hormones that raise the blood sugar level. There is also one other prescription for prediabetes that isn’t really a medication at all, but it works very well, and that is to lose some weight. Most people with prediabetes are overweight (you know who you are), and the more you weigh the more resistant your body is to the insulin you make, which means you need to make more, and so on. Hold on, hold on. Don’t stop reading yet! I can feel you tuning me out! I didn’t say you have to get skinny and svelte. Every little bit of weight you lose can lower your insulin resistance. Another way of thinking about that is that each pound you drop pushes diabetes further into the future. And that’s a prescription worth filling. Continue Learnin Continue reading >>

Prediabetes: What Can Doctors Call It?

Prediabetes: What Can Doctors Call It?

Prediabetes, intermediate hyperglycemia, insulin resistance, or abnormal blood glucose. No matter what you call it, the glucometabolic state that may precede diabetes is considered one that warrants preventive action. Internists know to screen patients for diabetes, but even if blood glucose levels fall short, they may still need to provide a diagnosis and treatment. Patients with higher-than-normal blood glucose levels are at increased risk for developing type 2 diabetes, cardiovascular disease, and stroke, according to the CDC. By the agency's estimates, 86 million U.S. adults have prediabetes, and 90% of them don't know it. This is not because nine out of 10 people aren't being screened, said Tannaz Moin, MD, MBA, MSHS, an assistant professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles. “People are being screened because doctors are thinking about diabetes, and we have pretty standardized guidelines on who should be screened. … But results in the prediabetes range is where I think there's confusion among patients and also clinicians,” she said. The confusion is understandable, as there have been questions about the diagnostic accuracy of the available screening tests, as well as about the evidence behind using an off-label drug to prevent diabetes. Some clinicians have even considered the term “prediabetes” to be a misnomer, as not all patients with elevated blood glucose levels go on to develop diabetes. Regardless of what term is used for the preceding condition, however, the goal of preventing diabetes remains worthwhile. Several experts offered their evidence-based tips for managing screening, diagnosis, and treatment. Defining prediabetes As of 2015, the U.S. Preventive Services Task Force (USPSTF) re Continue reading >>

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