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Metformin And Prediabetes

Metformin For Prediabetes

Metformin For Prediabetes

The oral biguanide metformin (Glucophage, and others) is generally the drug of choice for initial treatment of type 2 diabetes. It has also been used to prevent or at least delay the onset of diabetes in patients considered to be at high risk for the disease. Recent guidelines recommend considering use of metformin in patients with prediabetes (fasting plasma glucose 100-125 mg/dL, 2-hr post-load glucose 140-199 mg/dL, or A1C 5.7-6.4%), especially in those who are <60 years old, have a BMI >35 kg/m2, or have a history of gestational diabetes.1 Metformin has not been approved for such use by the FDA. CLINICAL STUDIES — In the Diabetes Prevention Program (DPP) trial, 3234 nondiabetic adults with a BMI ≥24 kg/m2 (≥22 kg/m2 in Asian patients) and elevated fasting and post-load plasma glucose concentrations were randomized to receive intensive lifestyle intervention focusing on weight loss and exercise, metformin 850 mg twice daily, or placebo.2 After a mean follow-up of 2.8 years, the incidence of diabetes was reduced, compared to placebo, by 58% with intensive lifestyle intervention and by 31% with metformin. Metformin was as effective as lifestyle intervention among patients <60 years old or with a BMI ≥35 kg/m2. When the 3-year DPP trial ended, the intensive lifestyle intervention group was offered semi-annual counseling and the metformin group could continue to take the drug. During a follow-up of 15 years, the average annual incidence of diabetes, compared to placebo, was 27% lower in patients originally randomized to lifestyle intervention and 18% lower in those randomized to metformin.3 ADVERSE EFFECTS — No significant safety issues have been detected with long-term use of metformin. The drug can cause adverse gastrointestinal effects such as metallic taste Continue reading >>

Prediabetes

Prediabetes

What Is Prediabetes? Prediabetes is a “pre-diagnosis” of diabetes—you can think of it as a warning sign. It’s when your blood glucose level (blood sugar level) is higher than normal, but it’s not high enough to be considered diabetes. Prediabetes is an indication that you could develop type 2 diabetes if you don’t make some lifestyle changes. But here's the good news: . Eating healthy food, losing weight and staying at a healthy weight, and being physically active can help you bring your blood glucose level back into the normal range. Diabetes develops very gradually, so when you’re in the prediabetes stage—when your blood glucose level is higher than it should be—you may not have any symptoms at all. You may, however, notice that: you’re hungrier than normal you’re losing weight, despite eating more you’re thirstier than normal you have to go to the bathroom more frequently you’re more tired than usual All of those are typical symptoms associated with diabetes, so if you’re in the early stages of diabetes, you may notice them. Prediabetes develops when your body begins to have trouble using the hormone insulin. Insulin is necessary to transport glucose—what your body uses for energy—into the cells via the bloodstream. In pre-diabetes, your body either doesn’t make enough insulin or it doesn’t use it well (that’s called insulin resistance). If you don’t have enough insulin or if you’re insulin resistant, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps prediabetes. Researchers aren’t sure what exactly causes the insulin process to go awry in some people. There are several risk factors, though, that make it more likely that you’ll develop pre-diabetes. These are Continue reading >>

Experts Recommend Two-pronged Approach To Treating Prediabetes

Experts Recommend Two-pronged Approach To Treating Prediabetes

According to the most recent data compiled by the CDC, 57 million U.S. adults have prediabetes, a figure that has reached pandemic levels. “In an ideal world, you want to diagnose high-risk people early in order to prevent progression to full-blown diabetes and its associated complications,” Glenn Matfin, MD, clinical associate professor at New York University and senior staff physician at the Joslin Diabetes Center, told Endocrine Today. Whether prediabetes progresses to diabetes depends on a number of variable factors, including lifestyle changes, genetics and treatment practices, which have some physicians supporting the use of medication and others vehemently against it. “We draw lines in order to differentiate between normal glucose tolerance, prediabetes and diabetes, but it is an interlinked, continuous chain,” Matfin said. “The clock is ticking, and the health risks rise significantly as prediabetes goes untreated.” To examine the current state of prediabetes treatment, Endocrine Today spoke with a number of experts to best understand how lifestyle and pharmacological approaches should be utilized to reverse glucose functions to normal levels. The issue is also examined from a financial aspect, as the ability to keep patients with prediabetes from turning into patients with diabetes translates into hundreds of millions of dollars saved in health care costs. Ralph DeFronzo, MD, and diabetes experts discuss preferred therapeutic approaches for people with prediabetes. Perhaps due to its subtle set of symptoms, the identification and diagnosis of patients with prediabetes has proved to be a challenge. Research has shown that although 30% of the U.S. population had prediabetes in 2005 to 2006, only 7.3% were aware that they had it. A consensus from diabe 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 >>

Metformin Or Lifestyle Modification In The Treatment Of Pre-diabetes

Metformin Or Lifestyle Modification In The Treatment Of Pre-diabetes

Metformin or lifestyle modification in the treatment of pre-diabetes Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program BMJ 2015; 350 doi: (Published 19 February 2015) Cite this as: BMJ 2015;350:h454 Metformin or lifestyle modification in the treatment of pre-diabetes The present article (1) has provided leads to the effectiveness of lifestyle modifications in reducing the incidence of diabetes from a pre-diabetes state in the general population. The common concept of initiating metformin for the treatment of pre-diabetic state, as the only effective measure seems to be limited with the findings of this study. Though metformin treatment reduced the incidence by 21.5% in absolute terms, the benefit was maximal in the quarter with the highest risk of developing diabetes. The effect of lifestyle modification, on the other hand showed six fold reduction in absolute risk (28.3%) in the highest risk quarter, which is higher than metformin group. A meta-analysis study (2) done on three randomized clinical trials showed that metformin decreases the rate of conversion from prediabetes to diabetes. The effective dose was 850 mg twice daily and lower dosage 250 mg twice or 3 times daily was not very effective. The studies were done in people of varied ethnicity. The number needed to treat was between 7 and 14 for treatment over a 3-year period. The study showed variations in the in overall rates of progression to diabetes in these 3 groups. The study from China(3)had an overall rate of conversion to diabetes of 10%; while that from India (4) showed a conversion rate of 48%. In the study(5) with mixed ethnicity (55% white, 20% African American, and only 5% Asian), a rate of conversion to diabetes was 24%. The a Continue reading >>

Metformin For Prediabetes

Metformin For Prediabetes

Prediabetes is, for many people, a confusing condition. It’s not quite Type 2 diabetes — but it’s not quite nothing, either. So how concerned should you be about it? For years, the jargon-filled names given to this condition — impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) — may have made the task of taking it seriously more difficult. But in 2002, the American Diabetes Association (ADA), along with the U.S. Department of Health and Human Services, inaugurated the term “prediabetes” to convey the likely result of not making diet or lifestyle changes in response to this diagnosis. In 2003, the threshold for prediabetes was lowered from a fasting glucose level of 110 mg/dl to one of 100 mg/dl. Then, in 2008, the American Diabetes Association (ADA) began recommending the drug metformin for some cases of prediabetes — specifically, for people under age 60 with a very high risk of developing diabetes, for people who are very obese (with a body-mass index, or BMI, of 35 or higher), and for women with a history of gestational diabetes. The ADA also said that health-care professionals could consider metformin for anyone with prediabetes or an HbA1c level (a measure of long-term blood glucose control) between 5.7% and 6.4%. But according to a recent study, metformin is still rarely prescribed for prediabetes. The study, published in April in the journal Annals of Internal Medicine, found that only 3.7% of people with prediabetes were prescribed metformin over a three-year period, based on data from a large national sample of adults ages 19 to 58. According to a Medscape article on the study, 7.8% of people with prediabetes with a BMI of 35 or higher or a history of gestational diabetes were prescribed metformin — still a very low rate for t 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 >>

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 >>

You’re ‘prediabetic’? Join The Club

You’re ‘prediabetic’? Join The Club

“The numbers don’t lie,” said the home page at doihaveprediabetes.org. “1 in 3 American adults has prediabetes.” The website invited me to take an online risk test, promising that it would require only a minute. The widely promoted site, part of a yearlong media campaign, bore the logos of the American Medical Association, the American Diabetes Association and the Centers for Disease Control and Prevention. About 292,000 people have taken the test. Make that 292,001. I clicked on the yellow button and gave my gender, race and age range. I responded to a couple of questions about family history and my own medical history, said that I was physically active, and filled in my height and weight. How did I do? “Based on these results, you’re likely to have prediabetes and are at high risk for Type 2 diabetes.” The site advised me to see my doctor for a blood test to confirm the results. I would be more worried about this if I hadn’t just read a new analysis in JAMA Internal Medicine. I’m in good company: The study found that more than 80 percent of Americans over age 60 would get the same warning. So would nearly 60 percent of those over age 40, an estimated 73.3 million people. The researchers, at Tufts Medical Center in Boston, used data from 10,175 participants in the National Health and Nutrition Examination Survey. Because Type 2 diabetes is a major and growing public health problem, experts certainly do want to help people avoid it. But how useful or meaningful is a test that identifies nearly every older person as likely to have prediabetes? As an accompanying editorial pointed out, it’s “a condition never heard of 10 years ago.” To the lead author, Dr. Saeid Shahraz, a specialist in predictive analysis and comparative effectiveness, the test Continue reading >>

Metformin For Prediabetes

Metformin For Prediabetes

This Issue The oral biguanide metformin (Glucophage, and others) is generally the drug of choice for initial treatment of type 2 diabetes. It has also been used to prevent or at least delay the onset of diabetes in patients considered to be at high risk for the disease. Recent guidelines recommend considering use of metformin in patients with prediabetes (fasting plasma glucose 100-125 mg/dL, 2-hr post-load glucose 140-199 mg/dL, or A1C 5.7-6.4%), especially in those who are <60 years old, have a BMI >35 kg/m2, or have a history of gestational diabetes.1 Metformin has not been approved for such use by the FDA. 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 >>

People With Pre-diabetes Who Drop Substantial Weight May Ward Off Type 2 Diabetes

People With Pre-diabetes Who Drop Substantial Weight May Ward Off Type 2 Diabetes

People with pre-diabetes who lose roughly 10 percent of their body weight within six months of diagnosis dramatically reduce their risk of developing type 2 diabetes over the next three years, according to results of research led by Johns Hopkins scientists. The findings, investigators say, offer patients and physicians a guide to how short-term behavior change may affect long-term health. “We have known for some time that the greater the weight loss, the lower your risk of diabetes,” says study leader Nisa Maruthur, M.D., M.H.S., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine. “Now we understand that we can see much of the benefit of losing that weight in those first six months when people are adjusting to a new way to eating and exercising. Substantial weight loss in the short term clearly should go a long way toward preventing diabetes.” Preventing pre-diabetes from becoming full-blown diabetes is critical, Maruthur says. Uncontrolled diabetes — marked by excess sugar in the blood — can lead to eye, kidney and nerve damage, as well as cardiovascular disease. The new research suggests that if people with pre-diabetes don’t lose enough weight in those first months, physicians may want to consider more aggressive treatment, such as adding a medication to push blood sugar levels lower. A report on the research is published online today in the Journal of General Internal Medicine. Maruthur and her colleagues based their conclusions on analysis of data from the Diabetes Prevention Program (DPP), the largest diabetes prevention study in the United States. Overweight, hyperglycemic people were recruited between 1996 and 1999 and followed for an average of 3.2 years. More than 3,000 particip Continue reading >>

Prediabetes - Medications

Prediabetes - Medications

XIAFLEX® is a prescription medicine used to treat adults with Dupuytren's contracture when a "cord" can be felt. It is not known if XIAFLEX® is safe and effective in children under the age of 18. Do not receive XIAFLEX® if you have had an allergic reaction to collagenase clostridium histolyticum or any of the ingredients in XIAFLEX®, or to any other collagenase product. See the end of the Medication Guide for a complete list of ingredients in XIAFLEX®. XIAFLEX® can cause serious side effects, including: Tendon rupture or ligament damage. Receiving an injection of XIAFLEX® may cause damage to a tendon or ligament in your hand and cause it to break or weaken. This could require surgery to fix the damaged tendon or ligament. Call your healthcare provider right away if you have trouble bending your injected finger (towards the wrist) after the swelling goes down or you have problems using your treated hand after your follow-up visit Nerve injury or other serious injury of the hand. Call your healthcare provider right away if you get numbness, tingling, increased pain, or tears in the skin (laceration) in your treated finger or hand after your injection or after your follow-up visit Hypersensitivity reactions, including anaphylaxis. Severe allergic reactions can happen in people who receive XIAFLEX® because it contains foreign proteins. Call your healthcare provider right away if you have any of these symptoms of an allergic reaction after an injection of XIAFLEX®: hives swollen face breathing trouble chest pain low blood pressure dizziness or fainting Increased chance of bleeding. Bleeding or bruising at the injection site can happen in people who receive XIAFLEX®. Talk to your healthcare provider if you have a problem with your blood clotting. XIAFLEX® may not b Continue reading >>

Biguanides (metformin) For Prediabetes And Type 2 Diabetes

Biguanides (metformin) For Prediabetes And Type 2 Diabetes

Biguanides (Metformin) for Prediabetes and Type 2 Diabetes Sometimes metformin is combined with other diabetes medicines in one pill. For example: Actoplus Met is a combination of metformin and pioglitazone. Avandamet is a combination of metformin and rosiglitazone. Duetact is a combination of metformin and glimepiride. Glucovance is a combination of metformin and glyburide. Janumet is a combination of metformin and sitagliptin. Jentadueto is a combination of metformin and linagliptin. Komboglyze is a combination of metformin and saxagliptin. Metaglip is a combination of metformin and glipizide. PrandiMet is a combination of metformin and repaglinide. Decreasing the amount of sugar produced by the liver. Increasing the amount of sugar absorbed by muscle cells. Metformin does not cause the pancreas to produce more insulin. It should not cause low blood sugar (hypoglycemia) or weight gain, unless it is taken in combination with medicines that do. Some people may lose weight when starting this medicine. These medicines are used to treat insulin resistance common to people with prediabetes , type 2 diabetes , and polycystic ovarian syndrome . Type 2 diabetes is a disease that can get worse over time, so medicines may need to change. Diabetes medicines work best for people who are being active and eating healthy foods. Studies have suggested that metformin lowers hemoglobin A1c by 1% to 2%. footnote 1 All medicines have side effects. But many people dont feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine. Here are some important things to think about: Usually the benefits of the medicine are more important than any minor Continue reading >>

Metformin Or Lifestyle Modification In The Treatment Of Pre-diabetes

Metformin Or Lifestyle Modification In The Treatment Of Pre-diabetes

The present article (1) has provided leads to the effectiveness of lifestyle modifications in reducing the incidence of diabetes from a pre-diabetes state in the general population. The common concept of initiating metformin for the treatment of pre-diabetic state, as the only effective measure seems to be limited with the findings of this study. Though metformin treatment reduced the incidence by 21.5% in absolute terms, the benefit was maximal in the quarter with the highest risk of developing diabetes. The effect of lifestyle modification, on the other hand showed six fold reduction in absolute risk (28.3%) in the highest risk quarter, which is higher than metformin group. A meta-analysis study (2) done on three randomized clinical trials showed that metformin decreases the rate of conversion from prediabetes to diabetes. The effective dose was 850 mg twice daily and lower dosage 250 mg twice or 3 times daily was not very effective. The studies were done in people of varied ethnicity. The number needed to treat was between 7 and 14 for treatment over a 3-year period. The study showed variations in the in overall rates of progression to diabetes in these 3 groups. The study from China(3) had an overall rate of conversion to diabetes of 10%; while that from India (4) showed a conversion rate of 48%. In the study (5) with mixed ethnicity (55% white, 20% African American, and only 5% Asian), a rate of conversion to diabetes was 24%. The advantage of lifestyle modification is also stressed by Tulso P (6) which showed that there is 20% decline in the development of diabetes from pre-diabetic state by lifestyle intervention and that too for as long as 10 years. It also showed that 6.9 persons are needed to participate in the lifestyle intervention programme to prevent 1 cas Continue reading >>

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