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How Effective Is Metformin For Type 2 Diabetes

What Next When Metformin Isn't Enough For Type 2 Diabetes?

What Next When Metformin Isn't Enough For Type 2 Diabetes?

› Turn first to metformin for pharmacologic treatment of type 2 diabetes. A › Add a second oral agent (such as a sulfonylurea, thiazolidinedione, sodium-glucose cotransporter-2 inhibitor, or dipeptidyl peptidase 4 inhibitor), a glucagon-like peptide-1 (GLP-1) receptor agonist, or basal insulin if metformin at a maximum tolerated dose does not achieve the HbA1c target over 3 months. A › Progress to bolus mealtime insulin or a GLP-1 agonist to cover postprandial glycemic excursions if HbA1c remains above goal despite an adequate trial of basal insulin. A Strength of recommendation (SOR) A Good-quality patient-oriented evidence B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, opinion, disease-oriented evidence, case series The "Standards of Medical Care in Diabetes" guidelines published in 2015 by the American Diabetes Association (ADA) state that metformin is the preferred initial pharmacotherapy for managing type 2 diabetes.1 Metformin, a biguanide, enhances insulin sensitivity in muscle and fat tissue and inhibits hepatic glucose production. Advantages of metformin include the longstanding research supporting its efficacy and safety, an expected decrease in the glycated hemoglobin (HbA1c) level of 1% to 1.5%, low cost, minimal hypoglycemic risk, and potential reductions in cardiovascular (CV) events due to decreased low-density lipoprotein (LDL) cholesterol.1,2 To minimize adverse gastrointestinal effects, start metformin at 500 mg once or twice a day and titrate upward every one to 2 weeks to the target dose.3 To help guide dosing decisions, use the estimated glomerular filtration rate (eGFR) instead of the serum creatinine (SCr) level, because the SCr can translate into a variable range of eGFRs (TABLE 1).4,5 What if metfo Continue reading >>

A Comprehensive Guide To Metformin

A Comprehensive Guide To Metformin

Metformin is the top of the line medication option for Pre-Diabetes and Type 2 Diabetes. If you must start taking medication for your newly diagnosed condition, it is then likely that your healthcare provider will prescribe this medication. Taking care of beta cells is an important thing. If you help to shield them from demise, they will keep your blood sugar down. This medication is important for your beta cell safety if you have Type 2 Diabetes. Not only does Metformin lower blood sugar and decrease resistance of insulin at the cellular level, it improves cell functioning, lipids, and how fat is distributed in our bodies. Increasing evidence in research points to Metformin’s effects on decreasing the replication of cancer cells, and providing a protective action for the neurological system. Let’s find out why Lori didn’t want to take Metformin. After learning about the benefits of going on Metformin, she changed her mind. Lori’s Story Lori came in worrying. Her doctor had placed her on Metformin, but she didn’t want to get the prescription filled. “I don’t want to go on diabetes medicine,” said Lori. “If I go on pills, next it will be shots. I don’t want to end up like my dad who took four shots a day.” “The doctor wants you on Metformin now to protect cells in your pancreas, so they can make more insulin. With diet and exercise, at your age, you can reverse the diagnosis. Would you like to talk about how we can work together to accomplish that?” “Reverse?” she asked. “What do you mean reverse? Will I not have Type 2 Diabetes anymore?” “You will always have it, but if you want to put it in remission, you are certainly young enough to do so. Your doctor wants to protect your beta cells in the pancreas. If you take the new medication, Continue reading >>

Metformin

Metformin

A popular oral drug for treating Type 2 diabetes. Metformin (brand name Glucophage, Glucophage XR, Glumetza, Riomet) is a member of a class of drugs called biguanides that helps lower blood glucose levels by improving the way the body handles insulin — namely, by preventing the liver from making excess glucose and by making muscle and fat cells more sensitive to available insulin. Metformin not only lowers blood glucose levels, which in the long term reduces the risk of diabetic complications, but it also lowers blood cholesterol and triglyceride levels and does not cause weight gain the way insulin and some other oral blood-glucose-lowering drugs do. Overweight, high cholesterol, and high triglyceride levels all increase the risk of developing heart disease, the leading cause of death in people with Type 2 diabetes. Another advantage of metformin is that it does not cause hypoglycemia (low blood glucose) when it is the only diabetes medicine taken. Metformin is typically taken two to three times a day, with meals. The extended-release formula (Glucophage XR) is taken once a day, with the evening meal. The most common side effects of metformin are nausea and diarrhea, which usually go away over time. A more serious side effect is a rare but potentially fatal condition called lactic acidosis, in which dangerously high levels of lactic acid build up in the bloodstream. Lactic acidosis is most likely to occur in people with kidney disease, liver disease, or congestive heart failure, or in those who drink alcohol regularly. (If you have more than four alcoholic drinks a week, metformin may not be the best medicine for you.) Unfortunately, many doctors ignore these contraindications (conditions that make a particular treatment inadvisable) and prescribe metformin to people Continue reading >>

Metformin Best For Type 2 Diabetes First Treatment

Metformin Best For Type 2 Diabetes First Treatment

HealthDay Reporter TUESDAY, Oct. 28, 2014 (HealthDay News) -- People newly diagnosed with type 2 diabetes who are initially given the drug metformin are less likely to eventually need other drugs to control their blood sugar, a new study suggests. The study found that, of those started on metformin, only about one-quarter needed another drug to control their blood sugar. However, people who were started on type 2 diabetes drugs other than metformin often needed a second drug or insulin to control their blood sugar levels, the researchers said. "This study supports the predominant practice, which is that most people are started on metformin," said lead researcher Dr. Niteesh Choudhry, an associate professor of medicine at Harvard Medical School in Boston. "Metformin might be more effective than others in controlling blood sugar," he noted. "Metformin, which is one of the oldest drugs we have and which the guidelines recommend as being the first drug to use, is associated with a lower risk of needing to add a second drug or insulin compared to any of three other commonly used classes of drugs," Choudhry said. The report was published in the Oct. 27 online edition of JAMA Internal Medicine. A hallmark of type 2 diabetes is insulin resistance, according to the American Diabetes Association (ADA). That means the body doesn't effectively use the hormone insulin. Insulin is produced by the pancreas and helps usher sugar from foods into the body's cells to be used as energy. When people have insulin resistance, too much sugar is left in the blood instead of being used. Over the long-term, high blood sugar levels can lead to serious complications, such as heart and kidney disease, according to the ADA. There are eight classes of oral type 2 diabetes medications, according to the Continue reading >>

Please Stay Away From These Drugs For Type 2 Diabetes

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 >>

Metformin Remains Best First-line Therapy For Type 2 Diabetes

Metformin Remains Best First-line Therapy For Type 2 Diabetes

Metformin Remains Best First-line Therapy for Type 2 Diabetes Metformin should remain the first choice for the treatment of type 2 diabetes, even in the face of competition from a host of newer agents, concludes a new review. Nisa M Maruthur, MD, of Johns Hopkins University School of Medicine, Baltimore, Maryland, led the review, published today in the Annals of Internal Medicine. "We conclude that metformin should remain a first-line therapy because its effect on HbA1c is similar to other medications. Metformin has a long-term safety profile, it's weight neutral or helps people lose weight, it has gastrointestinal side effects but they are avoidable or tolerable, and of course metformin looks better for cardiovascular mortality than sulfonylureas," she told Medscape Medical News in an interview. Among the drugs evaluated along with metformin were the latest approvals for type 2 diabetes, including the newest class of sodiumglucose cotransporter 2 (SGLT2) inhibitors, the dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagonlike peptide-1 (GLP-1) receptor agonists. Other drugs reviewed were thiazolidinediones, sulfonylureas, and selected metformin-based combinations. Asked to comment, Darren McGuire, MD, of the University of Texas Southwestern Medical Center, Dallas, remarked: "I do find it odd that the justification for metformin first hinges on its comparison with sulfonylureas, which have minimal data available suggesting efficacy and ongoing concern about adverse cardiovascular effects. "That is, it is possible that sulfonylureas have adverse outcomes, which of course in these analyses will exaggerate what, if any, cardiovascular risk efficacy metformin has." Review Includes Latest Data on Newer Agents Amid the plethora of newly approved antidiabetic drugs and an Continue reading >>

Metformin

Metformin

Tweet Metformin is an oral antidiabetic drug for the treatment of diabetes. Created by Bristol-Myers Squibb Company, Metformin is approved in the US and the UK as a treatment for type 2 diabetes. Click here to read our Diabetes and Metformin FAQs including information on lactic acidosis. Other Names for Metformin Metformin is sold both under brand names, and also as a generic drug. Common brand names include: Glucophage Riomet Fortamet Glumetza Obimet Dianben Diabex Diaformin Metformin Treatment Metformin contains the active ingredient metformin hydrochloride (or metformin hcl). Metformin is available both in combination with other drugs, or as a single treatment (a monotherapy). Metformin was approved in 1994 (in the USA) and is prescribed as: 500mg tablets 850mg tablets 500mg modified-release tablets 750mg modified-release tablets 1g modified-release tablets 1g oral powder sachets sugar free 500mg oral powder sachets sugar free 500mg/5ml oral solution sugar free Metformin SR Metformin is also available as metformin SR, a slow release or modified release form of the medication. Modified release versions of metformin may be prescribed for people experiencing significant gastro-intestinal intolerance as a result of standard metformin. Type 2 drug Metformin is a type 2 diabetic drug, and helps diabetics to respond normally to insulin. Like most diabetic drugs, the ultimate goals of Metformin are to lower blood sugar to a normal level and maintain this level. Metformin can be used in conjunction with other diabetic drugs, and diabetics should also use diet and exercise to help control their condition. How Metformin Works Metformin helps the body to control blood sugar in several ways. The drug helps type 2 diabetics respond better to their own insulin, lower the amount of Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Print Diagnosis To diagnose type 2 diabetes, you'll be given a: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood s Continue reading >>

New Information On How Metformin Works

New Information On How Metformin Works

Not only has new research told us how metformin really works, but a new biomarker was found that can determine the optimal dose of metformin that should be used to get the best results for each patient. Research from the Johns Hopkins Children’s Center reveals that the drug most commonly used in Type 2 diabetics who don’t need insulin works on a much more basic level than once thought, treating persistently elevated blood sugar — the hallmark of Type 2 diabetes — by regulating the genes that control its production. investigators say they have zeroed in on a specific segment of a protein called CBP made by the genetic switches involved in overproduction of glucose by the liver that could present new targets for drug therapy of the disease. In healthy people, the liver produces glucose during fasting to maintain normal levels of cell energy production. After people eat, the pancreas releases insulin, the hormone responsible for glucose absorption. Once insulin is released, the liver should turn down or turn off its glucose production, but in people with Type 2 diabetes, the liver fails to sense insulin and continues to make glucose. The condition, known as insulin resistance, is caused by a glitch in the communication between liver and pancreas. Metformin, introduced as frontline therapy for uncomplicated Type 2 diabetes in the 1950s, up until now was believed to work by making the liver more sensitive to insulin. The Hopkins study shows, however, that metformin bypasses the stumbling block in communication and works directly in the liver cells. Senior investigator, Fred Wondisford, M.D., who heads the metabolism division at Hopkins Children’s, tells us that, "Rather than an interpreter of insulin-liver communication, metformin takes over as the messenger itself Continue reading >>

Metformin Best As First Type 2 Diabetes Treatment

Metformin Best As First Type 2 Diabetes Treatment

MONDAY, Jan. 2, 2017 (HealthDay News) -- Newly updated guidelines reaffirm that metformin is the first-line drug for people with type 2 diabetes , and that several other medications -- including newer ones -- can be added if needed. The recommendations come from the American College of Physicians (ACP). The American Academy of Family Physicians endorsed the new guidelines. The ACP updated the guidelines because of new research into diabetes drugs, and the U.S. Food and Drug Administration approval of new diabetes drugs. "Metformin, unless contraindicated, is an effective treatment strategy because it has better effectiveness, is associated with fewer adverse effects, and is cheaper than most other oral medications," ACP president Dr. Nitin Damle said in a college news release. "The escalating rates of obesity in the U.S. are increasing the incidence and prevalence of diabetes substantially. Metformin has the added benefit of being associated with weight loss ," Damle said. The ACP recommends that if a patient needs to take a second drug by mouth to lower blood sugar levels , physicians should look at adding a sulfonylurea, thiazolidinedione, SGLT-2 inhibitor, or a DPP-4 inhibitor. Examples of sulfonylurea drugs include glyburide ( Diabeta , Glucovance , Micronase ), glimepiride , glipizide ( Glucotrol ) and tolbutamide . Thiazolidinedione drugs include pioglitazone (Actos) and rosiglitazone (Avandia). SGLT-2 inhibitors include canagliflozin (Invokana), empagliflozin (Jardiance) and dapagliflozin (Farxiga). DPP-4 inhibitors include sitagliptin ( Janumet , Januvia ) or linagliptin (Jentadueto, Tradjenta). Brand names for metformin include Glumetza , Glucophage , and Fortamet . "Adding a second medication to metformin may provide additional benefits," Damle said. "However Continue reading >>

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Abstract OBJECTIVE Metformin is the first-line oral medication recommended for glycemic control in patients with type 2 diabetes. We reviewed the literature to quantify the effect of metformin treatment on glycated hemoglobin (HbA1c) levels in all types of diabetes and examine the impact of differing doses on glycemic control. RESEARCH DESIGN AND METHODS MEDLINE, EMBASE, and the Cochrane Library were searched from 1950 to June 2010 for trials of at least 12 weeks’ duration in which diabetic patients were treated with either metformin monotherapy or as an add-on therapy. Data on change in HbA1c were pooled in a meta-analysis. Data from dose-comparison trials were separately pooled. RESULTS A total of 35 trials were identified for the main analysis and 7 for the dose-comparison analysis. Metformin monotherapy lowered HbA1c by 1.12% (95% CI 0.92–1.32; I2 = 80%) versus placebo, metformin added to oral therapy lowered HbA1c by 0.95% (0.77–1.13; I2 = 77%) versus placebo added to oral therapy, and metformin added to insulin therapy lowered HbA1c by 0.60% (0.30–0.91; I2 = 79.8%) versus insulin only. There was a significantly greater reduction in HbA1c using higher doses of metformin compared with lower doses of metformin with no significant increase in side effects. CONCLUSIONS Evidence supports the effectiveness of metformin therapy in a clinically important lowering of HbA1c used as monotherapy and in combination with other therapeutic agents. There is potential for using higher doses of metformin to maximize glycemic control in diabetic patients without increasing gastrointestinal effects. Metformin is the most commonly prescribed antihyperglycemic medication for diabetes in the U.S. (1) and the U.K. (2) and is the recommended first choice for oral therapy (2–4). T Continue reading >>

How Effective Is Metformin

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 >>

Metformin

Metformin

The most frequently prescribed medication for type 2 diabetes. Metformin does not cause weight gain, and is usually the first choice of medication to treat type 2 diabetes. Biguanide (Metformin) Metformin’s main site of action is at the liver to reduce the excessive sugar release seen in type 2 diabetes. Metformin does not cause weight gain, and is usually the first choice of medication to treat type 2 diabetes. However, if you have kidney or liver problems, heart failure, or are very sick, metformin cannot be used. The main side effects of metformin are diarrhea and stomach upset or cramping. It is important to take metformin with food to reduce stomach-related side effects. A very rare side effect (less than 1 person per 100,000 patients taking metformin) is lactic acidosis (a build-up of lactic acid in your blood). Lactic acidosis is very dangerous, and usually fatal. Generally, the people who develop this rare side effect are the ones who shouldn’t have been taking metformin in the first place (people with kidney problems or heart failure, or alcoholism). Metformin is also called a euglycemic, which means it may restore the blood sugar to normal or non-diabetic levels. If you are treated with metformin alone, you should not experience low blood sugars. And if you are treated with metformin and other blood sugar normalizing (“euglycemic”) agents (such as thiazolidinediones, starch blockers, or incretins) you also should not have low blood sugars. However, hypoglycemia or low blood sugars may develop when you take metformin together with insulin releasing pills and insulin, because they raise insulin levels and increase the risk of developing lows. In short, metformin decreases glucose production by the liver The most common side effects are: Diarrhea and stom Continue reading >>

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Abstract The management of T2DM requires aggressive treatment to achieve glycemic and cardiovascular risk factor goals. In this setting, metformin, an old and widely accepted first line agent, stands out not only for its antihyperglycemic properties but also for its effects beyond glycemic control such as improvements in endothelial dysfunction, hemostasis and oxidative stress, insulin resistance, lipid profiles, and fat redistribution. These properties may have contributed to the decrease of adverse cardiovascular outcomes otherwise not attributable to metformin’s mere antihyperglycemic effects. Several other classes of oral antidiabetic agents have been recently launched, introducing the need to evaluate the role of metformin as initial therapy and in combination with these newer drugs. There is increasing evidence from in vivo and in vitro studies supporting its anti-proliferative role in cancer and possibly a neuroprotective effect. Metformin’s negligible risk of hypoglycemia in monotherapy and few drug interactions of clinical relevance give this drug a high safety profile. The tolerability of metformin may be improved by using an appropiate dose titration, starting with low doses, so that side-effects can be minimized or by switching to an extended release form. We reviewed the role of metformin in the treatment of patients with type 2 diabetes and describe the additional benefits beyond its glycemic effect. We also discuss its potential role for a variety of insulin resistant and pre-diabetic states, obesity, metabolic abnormalities associated with HIV disease, gestational diabetes, cancer, and neuroprotection. Introduction The discovery of metformin began with the synthesis of galegine-like compounds derived from Gallega officinalis, a plant traditionally em Continue reading >>

What Comes After Metformin In Type 2 Diabetes?

What Comes After Metformin In Type 2 Diabetes?

What Comes After Metformin in Type 2 Diabetes? Does Choice of Second-line Therapy Affect Glycemic Control? Until 2012, the American Diabetes Association (ADA) recommended lifestyle and metformin as first-line therapy for glycemic management in type 2 diabetes, followed by a sulfonylurea (SU) or insulin for additional A1c reduction.[ 1 ] The rationale was that SUs were well validated as a glucose-lowering therapy, even though the risk for hypoglycemia was recognized, along with concerns about increased cardiovascular risk,[ 2 ] especially in combination with metformin.[ 3 ] Today, with many more second-line options available, the ADA's new guidelines[ 4 ] open the door to whichever therapy is best for the individual patient. But what exactly does that mean? Khunti and colleagues[ 5 ] analyzed data from 10,256 patients who initiated a second-line glucose-lowering therapy after treatment with metformin monotherapy between 2011 and 2014 in Germany and the United Kingdom. The main outcome of interest was change in A1c at 6 months. The researchers assessed the impact of various factors, including demographics, baseline A1c, time since diabetes diagnosis, and different types of second-line therapy, including SU or dipeptidyl peptidase-4 (DPP-4) inhibitor alone, SU or DPP-4 inhibitor with metformin, and insulin with or without other agents. Most patients added a therapy to metformin, the most common of which was SU (41%) followed by DPP-4 inhibitor (31%). Baseline A1c was 8.7% overall and 9.2% and 8.4% for SU and DPP-4 inhibitor combined with metformin, respectively. Patients initiating insulin experienced the largest absolute 6-month change in A1c (-2.1%), followed by those adding SU to metformin (-1.7%). However, after adjusting for baseline A1c, all therapies provided a dro Continue reading >>

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