Metformin And A1c Reduction

Effect Of Metformin Glycinate On Glycated Hemoglobin A1c Concentration And Insulin Sensitivity In Drug-naive Adult Patients With Type 2 Diabetes Mellitus

Go to: Abstract This study evaluated the effect of metformin glycinate on glycated hemoglobin A1c (A1C) concentration and insulin sensitivity in drug-naive adult patients with type 2 diabetes mellitus (T2DM). A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 patients with drug-naive T2DM. Ten subjects received metformin glycinate (1,050.6 mg) once daily during the first month and force-titrated twice daily during the second month. Ten additional patients received placebo as the control group. Before and after the intervention, metabolic profile including A1C and insulin sensitivity (euglycemic-hyperinsulinemic clamp technique) was estimated. A1C concentrations decreased significantly with metformin glycinate administration (8.0±0.7% vs. 7.1±0.9%, P=0.008) before and after the intervention, respectively. There were significant differences in changes from baseline of A1C between groups (0.0±0.7% vs. −1.0±0.5% for placebo and metformin glycinate groups, respectively; P=0.004). A reduction of ≥1% in A1C levels was reached in 60.0% of patients with metformin glycinate administration (P=0.02). Insulin sensitivity was not modified by the intervention. Administration of metformin glycinate during a 2-month period showed a greater decrease in A1C concentrations than placebo in a selected group of drug-naive adult patients with T2DM. Go to: In accordance with several algorithms for the medical treatment of patients with type 2 diabetes mellitus (T2DM), metformin hydrochloride along with lifestyle changes is the first line of treatment to achieve metabolic goals and, in combination with other oral agents or insulin, provides an efficacious therapeutic option.1,2 Metformin is a biguanide that activates the 5′-AMP-activated protein kinase Continue reading >>

Reduction In A1c Levels At 2 And 4 Years

Important Safety Information For Farxiga Prior serious hypersensitivity reaction to FARXIGA Severe renal impairment (eGFR <30 mL/min/1.73 m2), end-stage renal disease, or patients on dialysis Warnings and Precautions Hypotension: FARXIGA causes intravascular volume contraction, and symptomatic hypotension can occur. Assess and correct volume status before initiating FARXIGA in patients with impaired renal function, elderly patients, or patients on loop diuretics. Monitor for hypotension Ketoacidosis has been reported in patients with type 1 and type 2 diabetes receiving FARXIGA. Some cases were fatal. Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level. If suspected, discontinue FARXIGA, evaluate and treat promptly. Before initiating FARXIGA, consider risk factors for ketoacidosis. Patients on FARXIGA may require monitoring and temporary discontinuation in situations known to predispose to ketoacidosis Acute Kidney Injury and Impairment in Renal Function: FARXIGA causes intravascular volume contraction and renal impairment, with reports of acute kidney injury requiring hospitalization and dialysis. Consider temporarily discontinuing in settings of reduced oral intake or fluid losses. If acute kidney injury occurs, discontinue and promptly treat. FARXIGA increases serum creatinine and decreases eGFR. Elderly patients and patients with impaired renal function may be more susceptible to these changes. Before initiating FARXIGA, evaluate renal function and monitor periodically. FARXIGA is not recommended in patients with an eGFR persistently between 30 and <60 mL/min/1.73 m2 Urosepsis and Pyelonephritis: SGLT2 inhibitors increase the risk for urinary tract infections [UTIs] and serious UTIs have been Continue reading >>

Onglyza Is Proven To Lower A1c Levels

Important Safety Information Do not take ONGLYZA if you: are allergic to any of its ingredients. Serious allergic reactions can occur with ONGLYZA and may include swelling of the face, lips or throat, difficulty swallowing or breathing, swelling of the skin, hives, rash, itching, flaking, or peeling. If you have these symptoms, stop taking ONGLYZA and contact your doctor right away Serious side effects can happen in people who take ONGLYZA: Inflammation of the pancreas (pancreatitis) which may be severe and lead to death. Before taking ONGLYZA, tell your doctor if you ever had pancreatitis, gallstones, history of alcoholism, or high triglyceride levels. Stop taking ONGLYZA and contact your doctor right away if you have pain in your stomach area (abdomen) that is severe and will not go away. The pain may be felt going from your abdomen through to your back. The pain may happen with or without vomiting. These may be symptoms of pancreatitis Heart failure. Before taking ONGLYZA tell your doctor if you have ever had heart failure or problems with your kidneys. Contact your doctor right away if you have any of the following symptoms of heart failure: increasing shortness of breath or trouble breathing, especially when you lie down; an unusually fast increase in weight; swelling or fluid retention, especially in the feet, ankles or legs; unusual tiredness Low blood sugar. When ONGLYZA is used with certain other diabetes medicines to treat high blood sugar, such as a sulfonylurea or insulin, the risk of low blood sugar (hypoglycemia) is higher. Symptoms of low blood sugar include shaking, hunger, sweating, headache, rapid heartbeat, change in mood, and change in vision. Follow your doctor’s instructions for treating low blood sugar Joint pain. Some people who take medicines Continue reading >>

Metformin | Diabetesnet.com

Thu, 11/18/2010 - 15:57 -- Richard Morris Two drugs from the biguanide class, metformin and phenformin, were developed in 1957. Unfortunately, phenformin reached the U.S. market first and resulted in several deaths from lactic acidosis. When this risk surfaced, phenformin was pulled from drugstore shelves worldwide. Metformin was eventually found to be 20 times less likely to cause lactic acidosis, but it was tainted by the history of its cousin. Metformin first became available in France in 1979 and has been widely used in Europe since then, but it was not cleared for use in Type 2 diabetes in the U.S. until 1994. Target Organ: Liver, secondary effects on muscle and fat. Action: Lower glucose production by liver, increase number of insulin receptors Side Effects: bloating, fullness, nausea, cramping, diarrhea, vit B12 deficiency, headache, metallic taste, agitation, lactic acidosis Contraindications: DKA, alcoholism, binge drinking, kidney or liver disease, congestive heart failure, pregnancy, use of contrast media, surgery, heart attack, age > 80 Metformin is a chemical kin to the French lilac plant, which was noted in the early 1900’s to lower the blood sugar. However, French lilac, like phenformin, turned out to be too toxic for use in humans. Metformin, with a much shorter action time than phenformin, has a much lower risk for severe side effects and is quite safe for use by anyone who is otherwise healthy. In fact, in the major UKPDS study, it was the only drug that reduced diabetes-related death rates, heart attacks, and strokes. It should not be used by those who use more than two ounces or two drinks of alcohol a day, who have congestive heart failure, or who have significant kidney, liver, or lung disease. Metformin lowers fasting blood glucose levels by an Continue reading >>

The Effect Of Oral Antidiabetic Agents On A1c Levels

Abstract OBJECTIVE Previous reviews of the effect of oral antidiabetic (OAD) agents on A1C levels summarized studies with varying designs and methodological approaches. Using predetermined methodological criteria, we evaluated the effect of OAD agents on A1C levels. RESEARCH DESIGN AND METHODS The Excerpta Medica (EMBASE), the Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Cochrane Central Register of Controlled Trials databases were searched from 1980 through May 2008. Reference lists from systematic reviews, meta-analyses, and clinical practice guidelines were also reviewed. Two evaluators independently selected and reviewed eligible studies. RESULTS A total of 61 trials reporting 103 comparisons met the selection criteria, which included 26,367 study participants, 15,760 randomized to an intervention drug(s), and 10,607 randomized to placebo. Most OAD agents lowered A1C levels by 0.5−1.25%, whereas thiazolidinediones and sulfonylureas lowered A1C levels by ∼1.0–1.25%. By meta-regression, a 1% higher baseline A1C level predicted a 0.5 (95% CI 0.1–0.9) greater reduction in A1C levels after 6 months of OAD agent therapy. No clear effect of diabetes duration on the change in A1C with therapy was noted. CONCLUSIONS The benefit of initiating an OAD agent is most apparent within the first 4 to 6 months, with A1C levels unlikely to fall more than 1.5% on average. Pretreated A1C levels have a modest effect on the fall of A1C levels in response to treatment. Type 2 diabetes is a chronic, progressive disease that requires ongoing attention to lifestyle and pharmacotherapy to achieve and maintain optimal glucose control (1). Declining β-cell function and increasing insulin resistance over time lead to deteriorating glycemic control and the ne Continue reading >>

Metformin Forever

Metformin controls the insulin resistance of people who have type 2 diabetes so well that, if possible, all of us should be taking it. That’s what Roderic Crist, M.D., told me at the annual convention of the American Society of Bariatric Physicians in Denver this weekend. Dr. Crist specializes in family medicine in Cape Girardeau, Missouri. “Not everybody can take every drug,” he added, when I followed up our conversation by calling him at his office after he returned home. “But most of the time people can take metformin if they take it carefully.” Doctors increasingly prescribe it not only for type 2 diabetes but also for insulin resistance, polycystic ovary syndrome, and non-alcoholic fatty liver disease. Roughly one-third of Dr. Crist’s patients have diabetes. Well over half, if not two-thirds of the people he sees are insulin resistant. “I treat insulin resistance with that drug even if they aren’t fully diabetic.” he says. “If they have high triglyceride levels and low HDL levels, particularly if they are centrally obese, they should probably be on metformin. It helps slow the progression of the disease from one thing to the next.” But he goes further. He prescribes metformin to almost all of his patients who have type 2 diabetes — no matter how low their A1C level is. And he tells his patients that their levels should be 5.0 or less — not the American Diabetes Association’s less stringent recommendation of 7.0 or less. “If their A1C is at 5, their diabetes is in complete remission. So I have that as a goal.” And he still prescribes metformin to them after they reach that goal. “The two important issues are that it will prevent progression and it should be used in the earliest phases of insulin resistance. We vastly underutilize me Continue reading >>

Management Of Blood Glucose With Noninsulin Therapies In Type 2 Diabetes

A comprehensive, collaborative approach is necessary for optimal treatment of patients with type 2 diabetes mellitus. Treatment guidelines focus on nutrition, exercise, and pharmacologic therapies to prevent and manage complications. Patients with prediabetes or new-onset diabetes should receive individualized medical nutrition therapy, preferably from a registered dietitian, as needed to achieve treatment goals. Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications. Additional medications such as sulfonylureas, dipeptidyl-peptidase-4 inhibitors, thiazolidinediones, and glucagon-like peptide-1 receptor agonists should be added as needed in a patient-centered fashion. However, there is no evidence that any of these medications reduce the risk of diabetes-related complications, cardiovascular mortality, or all-cause mortality. There is insufficient evidence on which combination of hypoglycemic agents best improves health outcomes before escalating to insulin therapy. The American Diabetes Association recommends an A1C goal of less than 7% for many nonpregnant adults, with the option of a less stringent goal of less than 8% for patients with short life expectancy, cardiovascular risk factors, or long-standing diabetes. Randomized trials in middle-aged patients with cardiovascular risk factors have shown no mortality benefit and in some cases increased mortality with more stringent A1C targets. Clinical recommendation Evidence rating References Metformin should be used as first-line therapy to reduce microvascular complications, assist in weight management, reduce the risk of cardiovascular events, and reduce the risk of mortality in patients with type 2 diabetes mell Continue reading >>

Significant Reduction In A1c Levels When Patients Need More

Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio, and metformin plasma levels generally >5 mcg/mL. Risk factors include renal impairment, concomitant use of certain drugs, age >65 years old, radiological studies with contrast, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the Full Prescribing Information. If lactic acidosis is suspected, discontinue XIGDUO XR and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended. Contraindications Warnings and Precautions Hypotension: Dapagliflozin causes intravascular volume contraction, and symptomatic hypotension can occur. Assess and correct volume status before initiating XIGDUO XR in patients with impaired renal function, elderly patients, or patients on loop diuretics. Monitor for hypotension. Ketoacidosis has been reported in patients with type 1 and type 2 diabetes receiving dapagliflozin. Some cases were fatal. Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level. If suspected, discontinue XIGDUO XR, evaluate and treat promptly. Before initiating XIGDUO XR, consider risk factors for ketoacidosis. Patients on XIGDUO XR may require monitoring and temporary discontinuation in situations known to predispose to ketoacidosis. Acute Kidney Injury and Impai Continue reading >>

A1c Reduction Vs Metformin

I was wondering if anybody can confirm what I heard from my cardiologist. He said that 1000 mg metformin would make for 0.5 a1c reduction. I am 44 and 198 pounds. Still about 5-10 pounds in the wrong direction When I was diagnosed Type 2 in Dec 2010. My A1C was 10.7 and my weight 237 pounds. Started with 1000 mg metformin/20 mg simvastatin. Thru exercise/healthy eating my last A1C 2m ago was 5.5 and cholesterol was normal (70ish). Since last couple of months I went to 500 mg metformin and 2.5 mg simvastatin (been decreasing simvastatin gradually in 2011.) Basically, my belief is that diet/exercise/low stress would heal better than drugs and I want to get off metformin and simvastatin altogether. I typically do 30 min cardio in the morning, take 9 floors (210 steps) to my office at lunch time, and series of pushups and situps at night 6 days a week. I found 1000 mg of metformin was not enough for me. Over the past few years I have raised it to the max- 25550 mg. That keeps my bgs close to 100 most of the day. I let myself go to 110-120 after meals but prefer to be close to 100. I do about an hour-90 minutes of exercise most days, mostly walking. I lost weight for about 3 years but have been at 120-124 for about 2+ years. I would like to lose another few pounds but my body seems happy with my body set point. I was on a statin for about 15 months but it started to destroy my muscles so I stopped it. So far the Metformin has no side effects except good bgs and it actually helps in other ways, so I think I will stay on it although my bgs are good. When I was dx'd my bgs were in the 200-300 range and HbA1c was almost 11. So I have seen almost a 6 point drop. Although I have lost close to 30 pounds I was not overweight, high end of normal to start. 115 pounds, Breast Cancer d Continue reading >>

Januvia + Metformin: Strong A1c Lowering Vs Metformin Alone1

As an adjunct to diet and exercise for appropriate patients with type 2 diabetes In a clinical study including initial combination of sitagliptin + metformin, strong A1C lowering beyond metformin alone at week 24 (primary end point)a View Study Design 4 > aResults are adjusted for a 0.2% mean A1C increase for placebo; bP<0.001 vs respective monotherapies. LS = least squares; APaT = all-patients-as-treated. When added to a sulfonylurea (glimepiride) or insulin, patients treated with sitagliptin + metformin experienced a mean increase in body weight Percentage of patients with ≥1 episode of hypoglycemia over 24 weeks (APaT population) When added to a sulfonylurea (glimepiride) or insulin, patients treated with sitagliptin + metformin experienced increased incidence of hypoglycemia 12.2% for patients treated with JANUVIA + glimepiride ± metformin vs 1.8% for placebo + glimepiride ± metformin; 15.5% for patients treated with JANUVIA + insulin ± metformin vs 7.8% for placebo + insulin ± metformin. A lower dose of sulfonylurea or insulin may be required to reduce the risk of hypoglycemia. Established tolerability profile: Similar weight change with JANUVIA + metformin vs metformin alone1 Weight loss for sitagliptin + metformin was similar to metformin alone LS mean change from baseline at 24 weeks ranged from –1.3 lb to –2.9 lb (APaT population). When added to a sulfonylurea (glimepiride), patients treated with sitagliptin + metformin experienced a mean increase in body weight +1.8 lb for patients treated with JANUVIA + glimepiride ± metformin vs –0.9 lb for placebo + glimepiride ± metformin; +0.2 lb for patients treated with JANUVIA + insulin ± metformin vs +0.2 lb for placebo + insulin ± metformin. Important Information JANUVIA is indicated as an adjunct to Continue reading >>

Metformin And Insulin Resistance

About a year ago, my endocrinologist determined that I was exhibiting signs of insulin resistance. In short, my body requires more than the average amount of insulin to cover carbohydrate. She suggested that I start taking metformin, noting that it would do two things for me: It would decrease the amount of insulin I need to take and it would help curb my appetite, thus resulting in weight loss. When I first got on it, I thought it was great. My blood sugar levels improved, my appetite was in fact curbed, and all seemed wonderful — until I stopped taking my metformin. As a high school senior, I had atrocious sleeping habits! That, coupled with the fact that taking metformin was really killing my appetite, was causing me to become exhausted and get some pretty severe headaches. Looking back on it now, it’s very clear that the metformin wasn’t the problem, it was me. However, as a stubborn senior in high school, I was determined to maintain my sleeping habits, as I deemed them completely normal and in accordance with the typical behavior exhibited by my peers (boy, how I’ve changed…). So, I stopped the metformin. The last three weeks or so, I’ve been back on metformin regularly. I decided to start it up again after my last appointment with my CDE. Thus far, it’s really been working wonders and my blood sugars have decreased substantially! Where my 30-day average was hovering around 190 just a few weeks ago, it has now dropped to 137! I was seriously shocked when I saw how much my average fell. For the most part, my blood sugar levels are in range, but I have had my fair share of lows as well. Managing metformin really is a science that can change on a daily basis depending on my activity level. For example, the first two weeks that I was back on metformin, I Continue reading >>

Not At Goal On Metformin?

Ask your doctor about fighting type 2 diabetes harder by adding the pill that starts with “f” If you’re not reaching your A1C goal on metformin, you should know that adding once-daily FARXIGA to metformin therapy helped some patients lower their A1C more than metformin alone. The results of a clinical trial showed that patients taking FARXIGA 5 mg added on to metformin had an A1C reduction of 0.7 versus 0.3 with metformin alone. Although not a weight loss or blood pressure drug, FARXIGA may also provide weight loss and blood pressure benefits when taken with metformin. The results of a clinical trial showed that patients taking FARXIGA added on to metformin to lower their A1C also lost an average of 6.6 pounds, versus 2 pounds with metformin alone at 12 weeks. And results from the same study showed that taking FARXIGA added on to metformin also helped to lower systolic blood pressure. Remember, only your doctor can tell you if adding FARXIGA to your current metformin therapy could make a difference for you. Individual results may vary. Do not take FARXIGA if you have severe kidney problems or are on dialysis. Your healthcare provider should do blood tests to check how well your kidneys are working before and during your treatment with FARXIGA. FARXIGA may cause serious side effects including: Dehydration (the loss of body water and salt), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at a higher risk of dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); are 65 years of age or older; are on a low salt diet, or have kidney problems FARXIGA has been tested in 24 clinical studies that looked at its benefits and s Continue reading >>

Reducing Cv Risk In Diabetes: 'when' And 'how' Matter

Reducing CV Risk in Diabetes: 'When' and 'How' Matter Does Early Aggressive Therapy Reduce Risk? It is common knowledge that cardiovascular disease (CVD) is the single largest cause of morbidity and mortality in people with type 2 diabetes; it is also the largest contributor to the medical costs of diabetes.[ 1 ] Although lower A1c levels have long been associated with reduced CVD and mortality risk,[ 2 ] it isn't clear from recent major clinical trials that the act of lowering A1c is what reduces that risk.[ 3 , 4 , 5 ] Two new studies suggest that the keys to reducing CVD risk might be when and how A1c levels are lowered. An observational cohort study[ 6 ] from Denmark sought to determine the association between A1c levels achieved early in therapy, the magnitude of A1c reduction, and CVD events or death in patients with type 2 diabetes treated with metformin. All patients were aged 30 years or older and had initiated metformin monotherapy as their first-ever glucose-lowering treatment between 2000 and 2012, and had at least one A1c measurement within 12 months before therapy initiation and another within 2-6 months after therapy initiation (N = 24,752). The key analysis variables were the A1c levels after metformin initiation and the difference between the pre- and postinitiation A1c levels. Using Cox regression analyses, the researchers estimated the risk for myocardial infarction (MI), stroke, or all-cause mortality across strata of the key variables, adjusting for baseline demographic and clinical characteristics that could be associated with these outcomes. About 75% of the patients achieved A1c levels < 7%, and about half (54%) experienced an A1c change of at least 1%. After adjusting for confounders, the risk for the composite outcome increased with rising A1c Continue reading >>

The Effect Of Oral Antidiabetic Agents On A1c Levels

Go to: Previous reviews of the effect of oral antidiabetic (OAD) agents on A1C levels summarized studies with varying designs and methodological approaches. Using predetermined methodological criteria, we evaluated the effect of OAD agents on A1C levels. The Excerpta Medica (EMBASE), the Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Cochrane Central Register of Controlled Trials databases were searched from 1980 through May 2008. Reference lists from systematic reviews, meta-analyses, and clinical practice guidelines were also reviewed. Two evaluators independently selected and reviewed eligible studies. A total of 61 trials reporting 103 comparisons met the selection criteria, which included 26,367 study participants, 15,760 randomized to an intervention drug(s), and 10,607 randomized to placebo. Most OAD agents lowered A1C levels by 0.5−1.25%, whereas thiazolidinediones and sulfonylureas lowered A1C levels by ∼1.0–1.25%. By meta-regression, a 1% higher baseline A1C level predicted a 0.5 (95% CI 0.1–0.9) greater reduction in A1C levels after 6 months of OAD agent therapy. No clear effect of diabetes duration on the change in A1C with therapy was noted. The benefit of initiating an OAD agent is most apparent within the first 4 to 6 months, with A1C levels unlikely to fall more than 1.5% on average. Pretreated A1C levels have a modest effect on the fall of A1C levels in response to treatment. Treatment effects on A1C by OAD class, dose, and time. Error bars represent 95% CIs. ●, represent pooled, weighted mean differences. ○, represent individual comparison treatment effects. *Treatment effect 1.1 (95% CI 0.8–1.4). †Illustrates the generally accepted maximum daily dose. A, acarbose; AG-α, glucosidase inhibitors; Gm, glimepiri Continue reading >>

Efficacy | A1c Levels | Farxiga (dapagliflozin)

Prior serious hypersensitivity reaction to FARXIGA... Read More Severe renal impairment (eGFR <30 mL/min/1.73 m2), end-stage renal disease, or patients on dialysis Hypotension: FARXIGA causes intravascular volume contraction, and symptomatic hypotension can occur. Assess and correct volume status before initiating FARXIGA in patients with impaired renal function, elderly patients, or patients on loop diuretics. Monitor for hypotension Ketoacidosis has been reported in patients with type 1 and type 2 diabetes receiving FARXIGA. Some cases were fatal. Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level. If suspected, discontinue FARXIGA, evaluate and treat promptly. Before initiating FARXIGA, consider risk factors for ketoacidosis. Patients on FARXIGA may require monitoring and temporary discontinuation in situations known to predispose to ketoacidosis Acute Kidney Injury and Impairment in Renal Function: FARXIGA causes intravascular volume contraction and renal impairment, with reports of acute kidney injury requiring hospitalization and dialysis. Consider temporarily discontinuing in settings of reduced oral intake or fluid losses. If acute kidney injury occurs, discontinue and promptly treat. FARXIGA increases serum creatinine and decreases eGFR. Elderly patients and patients with impaired renal function may be more susceptible to these changes. Before initiating FARXIGA, evaluate renal function and monitor periodically. FARXIGA is not recommended in patients with an eGFR persistently between 30 and <60 mL/min/1.73 m2 Urosepsis and Pyelonephritis: SGLT2 inhibitors increase the risk for urinary tract infections [UTIs] and serious UTIs have been reported with FARXIGA. Evaluate for signs and sympto Continue reading >>