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 >>
Metformin Preferred Drug For Type 2 Diabetes, Experts Say
But, American College of Physicians states diet and exercise changes should start before medication Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. And "More information" links may no longer work. Questions about personal health should always be referred to a physician or other health care professional. HealthDay Reporter MONDAY, Feb. 6, 2012 (HealthDay News) -- When it comes to the treatment of type 2 diabetes, the first line of defense is lifestyle changes such as losing weight and exercising more often. But, if those lifestyle changes don't get blood sugar levels under control, the American College of Physicians (ACP) recommends the drug metformin as the first oral treatment that should be given. If metformin alone can't control blood sugar levels, the ACP advises combining metformin with another blood-sugar lowering medication. But, the evidence isn't yet strong enough for the doctor's group to recommend one medication over another for combination therapy. "Most diabetes medications do lower [blood sugar], but metformin is more effective with fewer side effects. And, the cost is less," said Dr. Amir Qaseem, director of clinical policy at the American College of Physicians, and the lead author of the new guidelines. However, the ACP is recommending that metformin only be prescribed after someone has tried to change his or her lifestyle, he added. "Diet, exercise and weight loss are so important in controlling type 2 diabetes. You can't just give pharmaceutical agents and not have lifestyle changes," Qaseem said. The new guidelines are published in the Feb. 7 issue of the Annals of Internal Medicine. Type 2 diabetes is a disease that causes high blood sugar levels Continue reading >>
Diabetes Drug That Could Help Us All Live Longer: Doctors Say It Could Also Stave Off Cancer
A drug widely prescribed to treat type 2 diabetes could help us all live longer, a study says. Research suggests metformin, which controls glucose levels, may also stave off cardiovascular disease and cancer – whether someone has diabetes or not. Scientists who studied more than 180,000 people found a ‘small but statistically significant improvement in survival’ in those taking metformin, compared with those given older anti-diabetic drugs and a group without diabetes. Scroll down for video However, experts said the five-and-a-half year follow-up period was relatively short, considering the complications of diabetes get worse over time and are linked with a shorter lifespan. Lead author Professor Craig Currie, from Cardiff University’s School of Medicine, said further research into the effects of metformin on healthy people was merited, particularly as it had negligible side effects. The drug costs a little over 10p a day for the highest prescribed dose. He said: ‘Patients treated with metformin had a small but statistically significant improvement in survival compared with non-diabetics, whereas those treated with sulphonylureas had a consistently reduced survival compared with non-diabetic patients. 'Surprisingly, the findings indicate that this cheap and widely prescribed diabetic drug may have beneficial effects not only on patients with diabetes but also for people without. ‘Metformin has been shown to have anti-cancer and anti-cardiovascular disease benefits. It can also reduce pre-diabetics’ chances of developing the disease by a third.’ But he said patients with type 2 diabetes would eventually see their health deteriorate, regardless of what drug they took. ‘People lose on average around eight years from their life expectancy after developing Continue reading >>
Metformin, The Liver, And Diabetes
Most people think diabetes comes from pancreas damage, due to autoimmune problems or insulin resistance. But for many people diagnosed “Type 2,” the big problems are in the liver. What are these problems, and what can we do about them? First, some basic physiology you may already know. The liver is one of the most complicated organs in the body, and possibly the least understood. It plays a huge role in handling sugars and starches, making sure our bodies have enough fuel to function. When there’s a lot of sugar in the system, it stores some of the excess in a storage form of carbohydrate called glycogen. When blood sugar levels get low, as in times of hunger or at night, it converts some of the glycogen to glucose and makes it available for the body to use. Easy to say, but how does the liver know what to do and when to do it? Scientists have found a “molecular switch” called CRTC2 that controls this process. When the CRTC2 switch is on, the liver pours sugar into the system. When there’s enough sugar circulating, CRTC2 should be turned off. The turnoff signal is thought to be insulin. This may be an oversimplification, though. According to Salk Institute researchers quoted on RxPG news, “In many patients with type II diabetes, CRTC2 no longer responds to rising insulin levels, and as a result, the liver acts like a sugar factory on overtime, churning out glucose [day and night], even when blood sugar levels are high.” Because of this, the “average” person with Type 2 diabetes has three times the normal rate of glucose production by the liver, according to a Diabetes Care article. Diabetes Self-Management reader Jim Snell brought the whole “leaky liver” phenomenon to my attention. He has frequently posted here about his own struggles with soarin Continue reading >>
6 Reasons Why Metformin Might Not Be Safe For Pcos
Have you been prescribed metformin for PCOS and are wondering what the side affects are? Metformin is often described as a ‘safe’ drug, but read on to find out why this might not be the case. When I was diagnosed with PCOS, the first thing I asked my GP was what I could take to ‘fix’ it. She gently explained that there was no pill or surgery that could cure my condition. However, there was a drug that could help with the elevated insulin levels caused by it. Metformin, she claimed, was a safe drug with no major side effects that would help with insulin resistance and weight loss. Sign me up. At first, I thought metformin was the wonder drug. I lost about 5kg in 4 months, more than I had ever been able to lose previously. I was ecstatic. I had a quick look online to see whether there were any side effects and initially found that diarrhea, loose stools, fatigue, and muscle soreness were commonly experienced. But I thought that it was small price to pay for finally being able to lose some weight. However, when I investigated further I found that that there are some much more sinister side effects of metformin that aren’t so widely publicised. These include: – Depleting our bodies of essential nutrients. – Increasing the risk of having a baby with a neural tube defect by up to 9 times. – Reducing energy levels by almost 50%. – Killing beneficial gut bacteria. This article is not intended to be a case against metformin for PCOS. There is no doubt that metformin helps to reduce weight, lowers blood glucose levels, and promotes ovulation. My concern is the lack of studies about the safety of long-term use of metformin for PCOS, especially in utero. Drugs can help with the associated symptoms of a disease, but they cannot fix the root cause of it. Metformin i Continue reading >>
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.[1] 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 >>
Why Doctors Are No Longer Prescribing Metformin
Www.passwordchallange.marriott.com     Cephalexin vs cefazolin      Buffalo wild wings ess payroll login Mar 20, 2017 . Fortunately for drugs like metformin, people who are not as disciplined and motivated can still have a long healthy life. I wish the best for my patients, that is why I highly recommend that they take the medications that their doctors prescribe in addition to diet and exercise. References. 1. Martin-Montalvo A . Aug 17, 2017 . Dear Dr. Roach • I have read online and in our local newspaper that doctors are no longer recommending metformin as a treatment for Type 2 diabetes. Can you please explain why metformin is no longer being prescribed? — P.K.. Answer • I, too, have seen online ads saying that      A recent study looks at the reasons why the drug metformin isn't more popular for Type 2 diabetes. Should doctors give it more consideration? Metformin (brand names Glucophage, Glucophage XR, Fortamet, Riomet, Glumetza, and others) is a popular and highly effective oral diabetes drug used to help manage. ★ Medicine For Diabetes Metformin ★★ Diabetes And Vertigo ::The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days.[ MEDICINE FOR DIABETES. Hi Stuie. Looks like you’re taking metformin and something else, no idea what keytone is. It’s always a good idea to look up what things interact with any. ★ Metformin Type 1 Diabetes ★★ Cure For Diabetes In Rats ::The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days.[ METFORMIN TYPE 1. Alex Zhavoronkov is the author of THE AGELESS GENERATION: How Advances in Biomedicine Will Transform the Global Economy ($27, Palgrave Macmillan). Metformin controls the insulin resistance Continue reading >>
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 >>
Metformin And Insulin In Type 2 Diabetes
the United Kingdom Prospective Diabetes Study Group (UKPDS) has pointed out that majority of type 2 diabetes patients will experience progressive pancreatic beta cell dysfunction even when their diabetes control is excellent (1) so type 2 diabetics may eventually require treatment with insulin when oral hypoglycaemic medication is no longer effective a straight swap to insulin treatment is usual if the maximal therapy with non-insulin treatments have been reached according to estimations in UK general practice, only 50% of patients who require insulin due to failure of oral medication will receive it within 5 years o the average time taken from beginning treatment with the last oral agent to beginning insulin therapy is around 8 years (2) in the case of overweight patients taking metformin, then treatment with metformin may be continued - this is because metformin may attenuate weight gain resulting from the introduction of insulin therapy insulin therapy and a sulphonylurea may decrease the amount of insulin actually required and enhance the use of a single night-time dose but overall the clinical advantages of this combination are small (3) the average weight gain resulting from introduction of insulin therapy is 4 kg - however some patients may have a marked increase in weight after onset of insulin therapy in a comprehensive review of combination therapies with insulin in type 2 diabetes Yki-Jarvinen suggests an algorithm for starting insulin in an insulin naive type 2 diabetic patient who is on maximal oral hypoglycaemic therapy. In this algorithm she suggests stopping sulphonylurea treatment and continuation of metformin at a dose of 2g per day in combination with insulin treatment (4). If the patient is not on a dose of 2g per day when conversion to insulin occur Continue reading >>
- Is It Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes
- Relative contribution of type 1 and type 2 diabetes loci to the genetic etiology of adult-onset, non-insulin-requiring autoimmune diabetes
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
Ignore The Clickbait: Metformin Still Prescribed For Diabetics
Dear Dr. Roach • I have read online and in our local newspaper that doctors are no longer recommending metformin as a treatment for Type 2 diabetes. Can you please explain why metformin is no longer being prescribed? — P.K. Answer • I, too, have seen online ads saying that doctors no longer prescribe metformin, and if you click through enough times, you find that “one weird food” cures diabetes, and that a special diet totally eliminates the need for medication for all diabetics. This is referred to as “clickbait,” and I encourage you not to pay attention to it. Metformin remains an important medication for many people with Type 2 diabetes, especially if they are overweight. For those people with diabetes who need medication despite an appropriate diet and regular exercise, metformin has been shown to be more beneficial, in terms of preventing diabetic complications and death, than most of the other medication options. It isn’t right for everyone, and people with poor kidney function may not be able to safely take it. Only your doctor, nurse practitioner or physician assistant knows what is best for you. Dear Dr. Roach • I started researching information about early dementia and also Alzheimer’s disease. I have perused numerous articles about cholinesterase inhibitors increasing acetylcholine levels that benefit the brain. Some medications are anticholinergic and might increase your risk of developing Alzheimer’s disease. Many of these medications are everyday, over-the-counter drugs. Shouldn’t the public be made aware of these drugs and their possible effect on our brain? — P.C. Answer • One type of treatment for Alzheimer’s disease is a class of drugs called cholinesterase inhibitors. These include donepezil (Aricept) and others. Pharmaco Continue reading >>
Why Isn’t Metformin Prescribed More?
Since its debut in the United States in 1995, metformin has become the most popular oral drug for Type 2 diabetes in the country — and the rest of the world. Current guidelines by the American Diabetes Association state that unless there are special risks in a particular person, metformin should be the first drug prescribed to people with Type 2 diabetes. Yet perhaps due in part to its popularity, metformin isn’t free of controversy. As we’ve discussed previously here at Diabetes Flashpoints, there are concerns about prescribing metformin in people with kidney disease, and some doctors even question whether metformin deserves its status as the universally recommended first-line drug for Type 2 diabetes. In addition, there’s debate about whether metformin should be taken by more people with prediabetes. A recent study sought to explore the reasons why metformin isn’t prescribed as widely as clinical guidelines suggest it should be. Published last month in the journal Therapeutic Advances in Chronic Disease, the study notes that only roughly 65% of people with newly diagnosed Type 2 diabetes are prescribed metformin — and that over time, this number drops to just 25% of people with the condition. As noted in a Pharmacy Times article on the study, researchers from the University of Colorado put together focus groups of relevant people — doctors, pharmacists, and other medical personnel — to ask about their perceptions regarding metformin. Based on these focus groups, the researchers found that three main factors affected how doctors prescribed metformin: concerns about when to start the drug, concerns about the drug’s known risks, and whether procedures were in place to notice and deal with any adverse reactions caused by the drug. Based on the focus grou Continue reading >>
Metformin Makes Headline News
Metformin is the first-line drug of choice in the treatment of type II diabetes. It was first approved in Europe in 1958.1 Americans had to wait until 1994 to legally obtain metformin.1 The holdup in approving metformin goes beyond the FDA. It is an indictment of a political/legal system that will forever cause needless suffering and death unless substantively changed. When Life Extension® informed Americans about drugs like metformin in the 1980s, the FDA did everything in its power to incarcerate me and shut down our Foundation.2 FDA propaganda at the time was that consumers needed to be "protected" against "unproven" therapies. As history has since proven, the result of the FDA's embargo has been unparalleled human carnage. So called "consumer protection" translated into ailing Americans being denied access to therapies that the FDA now claims are essential to saving lives. Today's major problem is not drugs available in other countries that Americans can't access. Instead, it is a political/legal system that suffocates medical innovation. Headline news stories earlier this year touted the anti-cancer effects of metformin, data that Foundation members were alerted to long ago.3 The problem is that it is illegal for metformin manufacturers to promote this drug to cancer patients or oncologists. It's also illegal to promote metformin to healthy people who want to reduce their risk of cancer, diabetes, vascular occlusion, and obesity. This fatal departure from reality continues unabated, as our dysfunctional political/legal system denies information about metformin that could spare countless numbers of lives. Type II diabetics suffer sharply higher rates of cancer4-7and vascular disease.8-11 The anti-diabetic drug metformin has been shown in numerous scientific studies Continue reading >>
Which Oral Agent To Use When Metformin Is No Longer Effective?
The history of the biguanide metformin is interesting. Although first synthesised over ninety years ago and known to have glucose lowering properties, its potential as a therapeutic agent in the treatment of diabetes was either ignored or forgotten about until the 1970s. It has now become perhaps the most widely prescribed oral anti-diabetic drug worldwide. It is easy to appreciate the reasons for its popularity. It is relatively cheap and has a proven effectiveness in improving glycaemic control in patients with type 2 diabetes (T2DM). It has, in addition, desirable cardiovascular protective properties and can enable prevention of weight gain. The drug has a reasonable safety profile as it has a low risk of causing significant hypoglycaemia; the more commonly described adverse effects are gastro-intestinal (described as being mild and short lived although many patients would dispute this) and a tendency to cause lactic acidosis in well described circumstances which admittedly are rare and preventable. In many respects therefore, metformin is almost an ideal therapeutic agent. Sadly, the experience of both patients and clinicians is that following an initial period of improved glycaemic control, it slowly fails to be effective when used on its own. The next step for many T2DM patients is to combine the use of metformin with insulin or another oral anti-diabetic agent. The review by Vella et al., considers the additional and alternative oral anti-diabetic therapeutic options that are currently available. Several families of anti-diabetic drugs are appraised in terms of known mode of action, effectiveness and safety. The sulphonylureas have the advantage of familiarity and low cost but are associated with hypoglycaemia and weight gain. The so-called gliptins represent a n Continue reading >>
Common Questions About Diabetes Medicines
How do I know if my diabetes pill is working? The best way to find out how well your diabetes pill is working is to test your blood sugar. Ask a member of your health care team what time of day is best for testing. You'll want to test when your diabetes medicine is expected to be most active in your body. Keep a record of your blood sugar levels (PDF) during that time to see if they're at or near your goal. If your levels are at or near your goal and you're not having any problems with the medicine, then it's probably working well. If you're still not sure, talk to your doctor or other member of your care team. Can I stop taking my diabetes medicine after my blood sugar is under control? It's reasonable to think that after a person gets good blood sugar control, it means the end of managing diabetes. But that's not the case. People with type 1 diabetes aren't able to make their own insulin, so they will always need to take insulin shots every day. For people with type 2 diabetes who are on medicine, the answer isn't as clear. Sometimes when people are first diagnosed, they start on pills or insulin right away. If the person also works hard to control diabetes with diet and exercise, he or she can lower the need for medicine and might be able to stop taking it altogether. As long as the person is able to keep blood sugar levels normal with diet and exercise, there isn't a need for medicine. However, type 2 diabetes changes over time. The change can be fast or slow, but it does change. This means that even if a person was able to stop taking medicine for a while, he or she might need to start taking it again in the future. If a person is taking medicine to keep blood sugar normal, then it's important to keep taking it to lower the chances for heart disease and other healt Continue reading >>
For Those With Diabetes, Older Drugs Are Often Best
WHEN it comes to prescription drugs, newer is not necessarily better. And that’s especially true when treating diabetes. One in 10 Americans has Type 2 diabetes. If the trend continues, one in three will suffer from the disease by the year 2050, according to the federal Centers for Disease Control and Prevention. Most Type 2 diabetes patients take one or more drugs to control blood sugar. They spent an estimated $12.5 billion on medication in 2007, twice the amount spent in 2001, according to a study by the University of Chicago. (That figure does not including drugs that diabetics are often prescribed for related health conditions, like high blood pressure and high cholesterol.) Why the increase? More diagnosed patients, more drugs per patient and an onslaught of expensive new drugs, according to Dr. G. Caleb Alexander, assistant professor of medicine at the University of Chicago and lead author of the study. Since 1995, several new classes of diabetes medications have come on the market. Diabetes drugs are important to the pharmaceutical industry, more lucrative than drugs for many other chronic diseases, Dr. Alexander noted in an interview. Simply put, many of these drugs help the body produce less glucose or more insulin, the hormone that shuttles glucose into cells for use as energy, or they increase the body’s sensitivity to its own insulin. Patients and health care professionals have long hoped that as pharmaceutical companies found ways to help the body lower blood sugar, they would produce safer and more efficient alternatives to older medications. But a true breakthrough doesn’t seem to have happened yet. A report released in March by the federal Agency for Healthcare Research and Quality and conducted by researchers at Johns Hopkins University reviewed Continue reading >>
