Deciding Oral Drugs After Metformin In Type 2 Diabetes: An Evidence-based Approach
Go to: With rapid changes in our understanding in etio-pathogenesis of type 2 diabetes (T2DM), there have been a paradigm shift in treatment modalities and currently entire focus is shifted from classical “triumvariate” to ominous “octet” concept. With this advancement, approach to diabetes management has also moved from being “gluco-centric” to “patient-centric.” The last two decades have witnessed the development of a wide variety of new therapeutic options to treat T2DM. Although each class of these agents broadly shows similar efficacy as monotherapy with hardly any clinically meaningful differences in glucose-lowering potency at least in short term, each therapeutic class has distinct adverse-event profile that either could be related to their specific mechanism of action and/or potential off-target effects. The glucose lowering did depend in part on the study design populations and baseline glycated hemoglobin (HbA1c) levels. Some of these adverse effects (in particular hypoglycemia and weight gain) could be clinically meaningful to patients and physicians, and it is conceivable that these adverse events may further increase the cardiovascular (CV) risk in T2DM or may negate the potential CV benefits of some of the glucose-lowering agents. Although there is general agreement and almost all recent guideline from American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) and American Association of Clinical Endocrinologist (AACE) recommends metformin as first-line drugs, uncertainty remains regarding the choice of second-line therapy once metformin is no longer effective. This review will discuss what could be possibly be the best option as a second-line oral agent once metformin monotherapy becomes ineffective, base Continue reading >>
After Metformin, Are Newer Drugs Better For Type 2 Diabetes?
After Metformin, Are Newer Drugs Better for Type 2 Diabetes? Use of a sulfonylurea as second-line therapy after metformin for type 2 diabetes is just as effective as a newer agent but far less costly, a new study based on claims data finds. The results were published online February 26 in Diabetes Care by Yuanhui Zhang, a PhD candidate at North Carolina State University, Raleigh, and colleagues. "In light of an incomplete understanding of the pros and cons of second-line medications and the high cost associated with newer medications, the decision to use newer medications should be weighed against the additional cost burden to patients and/or the health system," study coauthor Brian Denton, PhD, of the University of Michigan, Ann Arbor, told Medscape Medical News. However, the use of retrospective data means that the study is subject to both ascertainment and physician-choice bias, said Alan J. Garber, MD, PhD, of Baylor College of Medicine, Houston, Texas, when asked to comment for Medscape Medical News. Moreover, noted Dr. Garber, the study doesn't adequately account for the adverse effects of sulfonylurea-induced hypoglycemia. "Patients value things differently. If you had a hypoglycemic episode and you don't like that, you're willing to pay a lot more of your discretionary income to avoid having another one." The researchers explain that there are currently 11 classes of approved glucose-lowering medications. Metformin has a long-standing evidence base for efficacy and safety, is inexpensive, and is regarded by most as the primary first-line treatment for type 2 diabetes. When metformin fails to achieve or maintain glycemic goals, another agent needs to be added. However, there is no consensus or sufficient evidence supporting the use of one second-line agent over Continue reading >>
Metformin – What Every Diabetic Should Know
Diabetes affects millions of people throughout the world and for all the ones who know that they have it and are doing something to control it there will be just as many who do not know they have it. It is caused by the pancreas not creating enough insulin and this leaves you with too much sugar in the blood as your body can not process it properly. Metformin is a drug that is used to treat diabetes. Its main role is in regulating the amount of sugar in the body and this alone will help the diabetic. It only treats type 2 diabetes and there are other medicines available for those suffering from type 1. It is a member of a group of drugs known as biguanides and they have been used effectively for some time. How Does It Work? Metformin manages to control the amount of sugar in the blood in three distinct ways. Firstly it works on the food that you eat. Most foods have some degree of sugar in them and too much can cause the diabetes to become worse. The amount that the body absorbs is important and Metformin makes sure that not too much gets through. If too much does get through the body cannot deal with it and it is then that you become ill. Secondly it keeps down the amount of sugar that is produced by the liver. If this can be slowed down, there will be less sugar travelling around the body and the outcome will be that you are less likely to be ill. Its final function is to make sure that insulin is regulated. It works on both injected insulin and that produced naturally by the body. As a result of this some people who already have to inject may find that they no longer have to do this, or at least cut down the amount of times they have to do it. It will be important how much Metformin that you take and the amount will be prescribed by your doctor. This will be an exact Continue reading >>
Does Metformin Lose Its Effectiveness Over Time
Does Metformin Lose Its Effectiveness Over Time Does Metformin Lose Its Effectiveness Over Time How effective does Metformin remain when taken for long Metformin. How effective does Metformin remain to lose its effectiveness over time. When it does to lose weight. The combination of metformin Does metformin lose effectiveness over time? Is it better to 'diet'}" track_event="topic_hyperlink_clicked">diet and weight loss. So 'value': 'metformin'}" track_event="topic_hyperlink_clicked Metformin Forever - Mendosa "Almost all medications have side effects. For metformin the typical that the medication loses its effectiveness over time. loss does lead to lower blood Metformin ladies - Does it become less effective? - Trouble Does it become less effective?: Does metformin lose its effectiveness over have found that their cycles begin to lengthen again over time. does metforming lose its effectiveness? - Type 2 Diabetes does metforming lose its effectiveness? Little snack at night time before bed with my metformin. D is a progressive disease and over time you will have to Is Metformin Effective for Weight Loss? - Medscape Is Metformin Effective for Weight Loss? but were able to sustain the weight loss over 10 years. Effectiveness of metformin on weight loss in non-diabetic Does medicine lose its effectiveness after taking it for Posted in: diabetes, type 2, metformin, metformin Home Q & A Questions Does medicine lose its Does medicine lose its effectiveness after taking Please Stay Away from These Drugs for Type 2 Diabetes Ultimately all of these drugs lose their effectiveness over time and start a viscous cycle The most widely prescribed drug for type 2 diabetes is metformin metformin oral Reviews and User Ratings: Effectiveness, Ease and effectiveness of metformin oral. On t Continue reading >>
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Metformin: Improving Insulin Sensitivity
Metformin is the only medication in the biguanides category of blood glucose-lowering drugs approved by the U.S. Food and Drug Administration (FDA). Metformin has been available in the United States since the mid-1990s, when it received FDA approval. You may also know it by its brand name when it was under patent, Glucophage. Metformin is now widely available as a relatively inexpensive generic medication. Metformin’s main action is to decrease the overproduction of glucose by the liver, a common problem in prediabetes and type 2 diabetes. The action of metformin helps lower blood sugar levels particularly during the night to keep fasting glucose levels under control, but it also helps control blood glucose throughout the day. Metformin also increases the uptake of glucose by your muscles. Overall, metformin decreases insulin resistance and improves insulin sensitivity, thereby helping the insulin your body still makes work more effectively. People with prediabetes and in the early years of type 2 diabetes often continue to make some insulin, just not enough to control blood sugar levels alone. Metformin is not formally approved for use in prediabetes, and any use to treat prediabetes is considered off-label by providers. Since its approval, metformin has become the most commonly recommended blood glucose-lowering medication to treat type 2 diabetes. In recent years it has significantly replaced sulfonylureas, such as glipizide and glyburide. Today both the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the American Association of Clinical Endocrinologists (AACE) generally recommend that people with type 2 diabetes start taking metformin when they are diagnosed to help treat insulin resistance and maximize insulin s Continue reading >>
Does Metformin Counter The Helpfulness Of Birth Control? Does It Make Periods Heavy?
Home Q & A Questions Does Metformin counter the... Does Metformin counter the helpfulness of birth control? Does it make periods heavy? birth control , insulin resistance , polycystic ovary syndrome , metformin , period I have PCOS and I have been on birth control for about 2 years now to help control it and because I am sexually active. I started Metformin about 4 months ago since I was becoming insulin resistant. Recently every period I have been getting has been long and heavy, since I started taking metformin. Is this normal? Is the Metformin making the birth control not work? The periods are still during the placebo week, but I am worried about the effectiveness of the birth control since I am sexually active (and I am not trying to have a baby). Any help/advice would be appreciated, thanks! I don't know that this is the answer, but I have a guess. Young women with insulin resistance are likely to also have a co-morbid condition called PCOS (poly-cystic ovarian syndrome). High insulin levels (that you WOULD have had), and PCOS, would cause your ovaries to push out more androgen hormones, such as testosterone. The result of this would be acne, more body hair than usual, and fewer or irregular periods. What may be happening to your body is that the Metformin is regulating the amount of glucose in your blood, reversing the insulin resistance (i.e. making your body more sensitive to the insulin that your pancreas IS pushing out), and lowering your risk for diabetes. Your reproductive system may be starting to function more normally. I know many Many MANY women who have PCOS and have taken Metformin to initiate regular menstrual cycles, to be able to finally conceive. This is clearly not your intention, but your symptoms indicate that the Metforming is working exactly Continue reading >>
Please Stay Away From These Drugs For Type 2 Diabetes
Introduction The research is quite clear – oral medications to treat type 2 diabetes do not alter the long-term progression of the disease. While these drugs can be quite effective in the short term, several different types are associated with an increased chance of mortality and in particular, an increased risk for dying due to cardiovascular disease. In addition, often the type 2 diabetic fails to make necessary lifestyle and dietary changes to improve/reverse their condition because these drugs also create a false sense of security. Ultimately all of these drugs lose their effectiveness over time and start a viscous cycle where they are prescribed at higher dosages or in combination with other drugs, all of which leads to an even greater rate of mortality. In fact, the long-term use of some of these drugs is actually associated with an earlier death compared to control groups with type 2 diabetes not being given the drugs. Background Data: The most widely prescribed drug for type 2 diabetes is metformin (Glucophage). While studies have shown that metformin alone has illustrated a decrease in heart attacks and all diabetes related deaths compared with other drugs, it does not work at all in about 25 percent of cases and tends to lose its effectiveness with time. When the latter happens it is usually combined with a sulfonylurea, which actually increases mortality risk. On their own, these sulfonylureas drugs are of limited value and there is some evidence to indicate that sulfonylureas actually produce harmful long-term side-effects. For example, in a famous study conducted by the University Group Diabetes Program (UDGP), it was shown that the rate of death due to a heart attack or stroke was 2.5 times greater in the group taking tolbutamide (a sulfonylurea), than t Continue reading >>
How Long The Effectiveness Metformin ?
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community I have an important question . Regarding the duration of metformin It means that I am allowed to eat food after the dose I don't have idea Metformin is best taken whilst you are eating as that helps reduce any stomach problems. I am sorry my language betray me I mean how long Stability of blood sugar even if eaten after four hours I hope you understand me I am sorry my language betray me I mean how long Stability of blood sugar even if eaten after four hours I hope you understand me Ah. OK. Metformin doesn't work that way. It works by helping to reduce the amount of natural glucose produced by the liver and sent to the blood stream. It also helps a little bit with insulin resistance. It is mainly an appetite suppressant. so it helps overweight people the most. It doesn't do anything to stabilise blood glucose. It also accumulates in your body and doesn't "run out" every day like some medicines do. As long as you take the Metformin with food, it doesn't matter when you take it or when you eat. Does that help? Metformin does not work like insulin or other medication that induce insulin production. It works by reducing glucose production by the liver and reducing insulin resistance allowing the body to make better use of its own insulin. Consequently you do not take metformin is response or in preparation to a meal. You take it at fixed times as prescribed by your doctor and it then acts throughout the day. So in answer to your question you do not have to eat within a fixed time of taking metformin. As metformin can cause upset stomachs as a side effect for some people, it is customary to take metformin with a meal as this has been found to reduce the ch Continue reading >>
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How Effective Is Metformin
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community How effective is Metformin at lowering BG? I have recently kicked myself into touch and my recent HbA1c was 39mmol/mol, so quite pleased with that result. This was achieved through diet and exercise. I also lost a stone in weight and my BMI is now 27 instead of 30. I already take 2,000 Metformin sr and sitigliptin. But would eventually like to ditch the tablets when I am under better control. I don't really think that the meds have made much difference to my levels, as I seem to get better results through diet and exercise. Has anyone ditched the meds and had good results? Forgot to add that my HbA1c has gone down from 61mmol/mol to 39mmol/mol. In old money that's 7.7 down to 5.7 I've achieved this in 3 months with diet and exercise. I noticed that Metformin did not appear to be doing much regarding my blood sugar levels so I asked to stop taking them for three months. I didn't notice the difference to be honest but the doctor got a bit wound up when she found out. The HCP's are very insistent that you take them but give vague future benefits as to why that is. At the moment I am awaiting my test results after six months off all medication and according to my finger prick tests during that time I am expecting an acceptably low Hba1c. Metformin is pretty effective in Type 2 Diabetes. The research showed something like these figures .. ( from memory) doses of 2500 doesn't show much improvement on 2000 so it is usually said the minimum effective dose is 1500-2000 and people titrate up to that through 500 and 1000 to lessen initial gastrointestinal effects. If your A1c is 5.7 with metformin it would presumably be 6.9 without it. And of course the Sitaglip Continue reading >>
Hopes Of New Diabetes Drug With No Side Effects
The drug, which costs as little as 2p a day, is the gold standard treatment for obesity-triggered Type 2 diabetes and has been safely used for more than 50 years to control blood sugar levels. Yet one in 10 patients suffers side effects – nausea, loss of appetite and vomiting – and it can also become ineffective over time. One in 10 diabetics suffers side effects – nausea, loss of appetite and vomiting – and it can also become ineffective over time Now experts at the University of Pennsylvania School of Medicine have found that metformin works in a different way than previously thought. A team led by Dr Morris Birnbaum found in experiments on laboratory mice that the drug suppresses the ability of the hormone glucagon to generate a signalling molecule that stimulates glucose production. He said this new understanding means scientists can work on developing a new drug that works by mimicking the way the molecule is blocked by metformin. Type 2 diabetes patients suffer from an impaired production or effectiveness of insulin, the hormone made in the pancreas that helps control blood sugar levels. Metformin works by helping stop the liver from producing excess glucose and overcoming insulin resistance by making insulin carry glucose into muscle cells more effectively. Dr Birnbaum, whose findings are published in the journal Nature, said: “Overall metformin lowers blood glucose by decreasing liver production of glucose. But we didn’t really know how the drug accomplished that.” A revolutionary new treatment could transform lives of patients susceptible to metformin’s side effects. Type 2 sufferers are at higher risk of a host of debilitating conditions from heart disease, strokes and kidney failure to amputations and blindness. There are 2.9 million sufferers Continue reading >>
Metformin, Oral Tablet
Metformin oral tablet is available as both a generic and brand-name drug. Brand names: Glucophage, Glucophage XR, Fortamet, and Glumetza. Metformin is also available as an oral solution but only in the brand-name drug Riomet. Metformin is used to treat high blood sugar levels caused by type 2 diabetes. FDA warning: Lactic acidosis warning This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects. Lactic acidosis is a rare but serious side effect of this drug. In this condition, lactic acid builds up in your blood. This is a medical emergency that requires treatment in the hospital. Lactic acidosis is fatal in about half of people who develop it. You should stop taking this drug and call your doctor right away or go to the emergency room if you have signs of lactic acidosis. Symptoms include tiredness, weakness, unusual muscle pain, trouble breathing, unusual sleepiness, stomach pains, nausea (or vomiting), dizziness (or lightheadedness), and slow or irregular heart rate. Alcohol use warning: You shouldn’t drink alcohol while taking this drug. Alcohol can affect your blood sugar levels unpredictably and increase your risk of lactic acidosis. Kidney problems warning: If you have moderate to severe kidney problems, you have a higher risk of lactic acidosis. You shouldn’t take this drug. Liver problems warning: Liver disease is a risk factor for lactic acidosis. You shouldn’t take this drug if you have liver problems. Metformin oral tablet is a prescription drug that’s available as the brand name drugs Glucophage, Glucophage XR, Fortamet, and Glumetza. Glucophage is an immediate-release tablet. All of the other brands are extended-r Continue reading >>
Diabetes Drugs: Metformin
Editor’s Note: This is the second post in our miniseries about diabetes drugs. Tune in on August 21 for the next installment. Metformin (brand names Glucophage, Glucophage XR, Riomet, Fortamet, Glumetza) is a member of a class of medicines known as biguanides. This type of medicine was first introduced into clinical practice in the 1950’s with a drug called phenformin. Unfortunately, phenformin was found to be associated with lactic acidosis, a serious and often fatal condition, and was removed from the U.S. market in 1977. This situation most likely slowed the approval of metformin, which was not used in the U.S. until 1995. (By comparison, metformin has been used in Europe since the 1960’s.) The U.S. Food and Drug Administration (FDA) required large safety studies of metformin, the results of which demonstrated that the development of lactic acidosis as a result of metformin therapy is very rare. (A finding that has been confirmed in many other clinical trials to date.) Of note, the FDA officer involved in removing phenformin from the market recently wrote an article highlighting the safety of metformin. Metformin works primarily by decreasing the amount of glucose made by the liver. It does this by activating a protein known as AMP-activated protein kinase, or AMPK. This protein acts much like an “energy sensor,” setting off cellular activities that result in glucose storage, enhanced entry of glucose into cells, and decreased creation of fatty acids and cholesterol. A secondary effect of the enhanced entry of glucose into cells is improved glucose uptake and increased storage of glycogen (a form of glucose) by the muscles. Additionally, the decrease in fatty acid levels brought about by metformin may indirectly improve insulin resistance and beta cell func Continue reading >>
Steps To Take If Your Oral Diabetes Medication Stops Working
Oral medicines are effective at lowering blood sugar when diet and exercise aren’t enough to manage type 2 diabetes. Yet these drugs aren’t perfect — and they don’t always work in the long term. Even if you’ve been taking your medicine just as your doctor prescribed, you might not feel as well as you should. Diabetes drugs can and often do stop working. About 5 to 10 percent of people with type 2 diabetes stop responding to their medicine each year. If your oral diabetes drug is no longer working, you’ll need to figure out what’s preventing it from controlling your blood sugar. Then you’ll have to explore other options. Look at your daily habits When your oral diabetes medicine stops working, make an appointment with your doctor. They will want to know if anything in your routine has changed. Many factors can affect how well your medicine is working — for instance, weight gain, changes in your diet or activity level, or a recent illness. Making a few changes to your diet or exercising more each day might be enough to get your blood sugar under control again. It’s also possible that your diabetes has progressed. The beta cells in your pancreas that produce insulin can become less efficient over time. This can leave you with less insulin and poorer blood sugar control. Sometimes your doctor may not be able to figure out why your medicine stopped working. If the drug you’ve been taking is no longer effective, you’ll need to look at other medications. Add another drug Metformin (Glucophage) is often the first drug you’ll take to control type 2 diabetes. If it stops working, the next step is to add a second oral drug. You have a few oral diabetes medicines to choose from, and they work in different ways. Sulfonylureas such as glyburide (Glynase Pres Continue reading >>
When Type 2 Diabetes Treatment Fails, What’s Next?
For most people, type 2 diabetes changes over time — even for those who follow their treatment plan exactly as directed. As the disease progresses, your diabetes care team can help you adjust your treatment plan and manage your blood sugar levels. If a change is needed, your doctor may add new diabetes medications or suggest starting an insulin regimen. This doesn’t mean you did something wrong — shifting gears is a natural part of managing a changing chronic disease like type 2 diabetes. There are a number of factors that can contribute to a decline in blood sugar control, says Margaret Powers, PhD, RD, CDE, past-president of health care and education for the American Diabetes Association and a research scientist at the International Diabetes Center at Park Nicollet Health Services in Minneapolis, Minnesota. When type 2 diabetes first develops, you may be insulin resistant, which means you make a lot of insulin but your body can’t use it effectively, Dr. Powers says. Then, over time, you make less insulin and become insulin deficient. “This is seen a lot, but it doesn’t happen overnight — it’s a gradual process,” says Powers. Other factors, including a significant change in weight, activity level, or diet, or starting new medications, can also affect blood sugar, she says. Stress is another factor that can impact your treatment. An additional illness or a major change like a divorce, job loss, or a loved one’s death can increase stress, which can raise blood sugar. These life changes may affect how well people take their medication, says Susan Weiner, RDN, a certified diabetes educator in New York and the 2015 Educator of the Year of the American Association of Diabetes Educators. “Before, there may have been someone who helped motivate and suppor Continue reading >>
Stopping Metformin: When Is It Ok?
The most common medication worldwide for treating diabetes is metformin (Glumetza, Riomet, Glucophage, Fortamet). It can help control high blood sugar in people with type 2 diabetes. It’s available in tablet form or a clear liquid you take by mouth before meals. Metformin doesn’t treat the underlying cause of diabetes. It treats the symptoms of diabetes by lowering blood sugar. It also increases the use of glucose in peripheral muscles and the liver. Metformin also helps with other things in addition to improving blood sugar. These include: lowering lipids, resulting in a decrease in blood triglyceride levels decreasing “bad” cholesterol, or low-density lipoprotein (LDL) increasing “good” cholesterol, or high-density lipoprotein (HDL) If you’re taking metformin for the treatment of type 2 diabetes, it may be possible to stop. Instead, you may be able to manage your condition by making certain lifestyle changes, like losing weight and getting more exercise. Read on to learn more about metformin and whether or not it’s possible to stop taking it. However, before you stop taking metformin consult your doctor to ensure this is the right step to take in managing your diabetes. Before you start taking metformin, your doctor will want to discuss your medical history. You won’t be able to take this medication if you have a history of any of the following: alcohol abuse liver disease kidney issues certain heart problems If you are currently taking metformin, you may have encountered some side effects. If you’ve just started treatment with this drug, it’s important to know some of the side effects you may encounter. Most common side effects The most common side effects are digestive issues and may include: diarrhea vomiting nausea heartburn abdominal cramps Continue reading >>