Long-term Treatment With Metformin In Obese, Insulin-resistant Adolescents: Results Of A Randomized Double-blinded Placebo-controlled Trial
As adolescents with obesity and insulin resistance may be refractory to lifestyle intervention therapy alone, additional off-label metformin therapy is often used. In this study, the long-term efficacy and safety of metformin versus placebo in adolescents with obesity and insulin resistance is studied. In a randomized placebo-controlled double-blinded trial, 62 adolescents with obesity aged 10–16 years old with insulin resistance received 2000 mg of metformin or placebo daily and physical training twice weekly over 18 months. Primary end points were change in body mass index (BMI) and insulin resistance measured by the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Secondary end points were safety and tolerability of metformin. Other end points were body fat percentage and HbA1c. Forty-two participants completed the 18-month study (66% girls, median age 13 (12–15) years, BMI 30.0 (28.3 to 35.0) kg m−2 and HOMA-IR 4.08 (2.40 to 5.88)). Median ΔBMI was +0.2 (−2.9 to 1.3) kg m−2 (metformin) versus +1.2 (−0.3 to 2.4) kg m−2 (placebo) (P=0.015). No significant difference was observed for HOMA-IR. No serious adverse events were reported. Median change in fat percentage was −3.1 (−4.8 to 0.3) versus −0.8 (−3.2 to 1.6)% (P=0.150), in fat mass −0.2 (−5.2 to 2.1) versus +2.0 (1.2–6.4) kg (P=0.007), in fat-free mass +2.0 (−0.1 to 4.0) versus +4.5 (1.3 to 11.6) kg (P=0.047) and in ΔHbA1c +1.0 (−1.0 to 2.3) versus +3.0 (0.0 to 5.0) mmol mol−1 (P=0.020) (metformin versus placebo). Long-term treatment with metformin in adolescents with obesity and insulin resistance results in stabilization of BMI and improved body composition compared with placebo. Therefore, metformin may be useful as an additional therapy in combination with lifes Continue reading >>
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Reducing Metformin - Any Side Effects?
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community My results from my review this morning were good - HBA1c of 40, cholesterol of 3.1,both showing a small but steady decrease over the last few years (along with my weight). I'm currently on 3 metformin/day, and given my results I broached with my GP the possibility of reducing my MF to 2/day, he's OK with it but of course wants to have my blood checked 3 - 4 months down the line to see if it's working. So before I embark on this - has anyone reduced their MF intake and if so, are there any side effects? Background is that in 2012 my dosage was increased to 3/day from 2. At that time my hba1c was 53, over the intervening years (annual review) it came down to 48, 44, 42, and now 40 and my weight has shown c2kg/year reduction in the same period. As well as increasing the MF intake at the end of 2012 I also increased my exercise levels and tweaked my diet slightly, so I guess all of these things contributed. My results from my review this morning were good - HBA1c of 40, cholesterol of 3.1,both showing a small but steady decrease over the last few years (along with my weight). I'm currently on 3 metformin/day, and given my results I broached with my GP the possibility of reducing my MF to 2/day, he's OK with it but of course wants to have my blood checked 3 - 4 months down the line to see if it's working. So before I embark on this - has anyone reduced their MF intake and if so, are there any side effects? Background is that in 2012 my dosage was increased to 3/day from 2. At that time my hba1c was 53, over the intervening years (annual review) it came down to 48, 44, 42, and now 40 and my weight has shown c2kg/year reduction in the same period. As well as Continue reading >>
Metformin For Enhancement - A Hot Area Of Debate For The Future
Metformin for Enhancement - A Hot Area of Debate for the Future Metformin is a drug that is used to increase the body's sensitivity to insulin. While normally its usage is limited to diabetes, recent research has implicated that it may be beneficial for enhancement purposes in people that do not have diabetes. A 15-year long observational study showed that metformin was useful for preventing metabolic deficits related to diabetes (resulted in lower BMI and and Hemoglobin A1c values) 1 , and a number of studies have shown that metformin was useful for prolonging lifespan. These findings are prominent and the usage of metformin people that do not have diabetes should be given more emphasis in research and perhaps become a standard of care in the future. Metformin in people that are not diabetic In most medical circles, metformin is reserved for people that have diabetes. However, there is an emerging body of scientific research that shows evidence for the efficacy of metformin for improving longevity and improving insulin sensitivity, even if the body is in a healthy state. A very interesting study was published in 2015 on a 15-year intervention period for 2,776 people at risk (but do not have diabetes). Participants that were identified as having a moderate risk for developing diabetes were given metformin as a preventative measure. This group of participants was matched by a participant group that got placebo treatment, as well as a group that was instructed to make lifestyle modifications (exercise and diet) for prevention purpose. It was found that over a long period of 15 years after starting treatments, the incidence of diabetes in the people that took metformin was dramatically lower than in people that had placebo treatment (60% incidence in placebo, 52% in metfo Continue reading >>
The Potential Of Metformin For Diabetes Prevention - Sciencedirect
The potential of metformin for diabetes prevention Get rights and content Well designed intervention trials, such as the Diabetes Prevention Program (DPP), have demonstrated the potential of lifestyle interventions or pharmacologic treatments for the prevention or delay of type 2 diabetes in subjects with impaired glucose tolerance (IGT). Lifestyle interventions are likely to form the cornerstone of the management of IGT in the future, as they do in the management of type 2 diabetes today. However, it remains to be seen whether the intensive lifestyle interventions employed in trials such as the DPP can be transferred successfully from the highly structured environment of a randomised trial to routine, day-to-day management within the primary care sector. Thus, pharmacologic treatment may provide an important additional option where subjects are unwilling or unable to improve their diet and levels of physical activity. Treatment with metformin significantly reduced the incidence of diabetes in subjects with IGT and high-normal fasting plasma glucose in the DPP. Moreover, metformin was well tolerated, and health economic analyses suggest that metformin treatment is cost-effective in the US and Europe. The DPP investigators found that the protective effect of metformin persisted beyond the end of the study, and estimated that only one quarter of the protection arose from a short-lived pharmacological effect. The results of the DPP identify metformin as an effective option for the prevention of diabetes in subjects with IGT and impaired fasting glucose. Continue reading >>
Efficacy | Add-on To Metformin | 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 >>
Metformin
Metformin, marketed under the trade name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes,[4][5] particularly in people who are overweight.[6] It is also used in the treatment of polycystic ovary syndrome.[4] Limited evidence suggests metformin may prevent the cardiovascular disease and cancer complications of diabetes.[7][8] It is not associated with weight gain.[8] It is taken by mouth.[4] Metformin is generally well tolerated.[9] Common side effects include diarrhea, nausea and abdominal pain.[4] It has a low risk of causing low blood sugar.[4] High blood lactic acid level is a concern if the medication is prescribed inappropriately and in overly large doses.[10] It should not be used in those with significant liver disease or kidney problems.[4] While no clear harm comes from use during pregnancy, insulin is generally preferred for gestational diabetes.[4][11] Metformin is in the biguanide class.[4] It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues.[4] Metformin was discovered in 1922.[12] French physician Jean Sterne began study in humans in the 1950s.[12] It was introduced as a medication in France in 1957 and the United States in 1995.[4][13] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[14] Metformin is believed to be the most widely used medication for diabetes which is taken by mouth.[12] It is available as a generic medication.[4] The wholesale price in the developed world is between 0.21 and 5.55 USD per month as of 2014.[15] In the United States, it costs 5 to 25 USD per month.[4] Medical uses[edit] Metformin is primarily used for type 2 diabetes, but is increasingly be Continue reading >>
Over Long Term, Diet And Exercise Are Best To Prevent Diabetes
September 25, 2015 / 3:17 PM / 3 years ago Over long term, diet and exercise are best to prevent diabetes (This story has been refiled to correct the affiliation of researcher in paragraph 3) A person receives a test for diabetes during Care Harbor LA free medical clinic in Los Angeles, California September 11, 2014. REUTERS/Mario Anzuoni (Reuters Health) - In a head-to-head comparison over 15 years, diet and exercise outperformed the drug metformin in preventing people at high risk for diabetes from developing the disease. Metformin, which helps control blood sugar and can be used alone or in combination with insulin to treat type 2 diabetes, also lowered the risk of developing the disorder in the study group, just not as much as making healthy lifestyle changes did. The lifestyle intervention was more powerful in preventing or delaying diabetes development during the original three-year Diabetes Prevention Program and remains more powerful over the entire 15-year study, said professor David M. Nathan of the Massachusetts General Hospital in Boston, a coauthor of the new paper. However, there are specific subgroups in which the lifestyle intervention had an even more powerful effect specifically, those older than age 60, Nathan told Reuters Health by email. Metformin was relatively more effective in people younger than 60 and those who were more obese, he said. The researchers followed up with the surviving participants of a diabetes prevention study between 1996 and 2001 that compared people randomly assigned to either an intensive lifestyle intervention or 850 milligrams of metformin twice daily and a group taking a placebo. The participants were all overweight or obese and had elevated blood sugar levels, both factors that put them at very high risk for developing Continue reading >>
Improved Endothelial Function With Metformin In Type 2 Diabetes Mellitus - Sciencedirect
Volume 37, Issue 5 , April 2001, Pages 1344-1350 Author links open overlay panel Kieren JMatherMD SubodhVermaMD, PhD Todd JAndersonMD This study was designed to assess the effect of metformin on impaired endothelial function in type 2 diabetes mellitus. Abnormalities in vascular endothelial function are well recognized among patients with type 2 (insulin-resistant) diabetes mellitus. Insulin resistance itself may be central to the pathogenesis of endothelial dysfunction. The effects of metformin, an antidiabetic agent that improves insulin sensitivity, on endothelial function have not been reported. Subjects with diet-treated type 2 diabetes but without the confounding collection of cardiovascular risk factors seen in the metabolic syndrome were treated with metformin 500 mg twice daily (n = 29) or placebo (n = 15) for 12 weeks. Before and after treatment, blood flow responses to intraarterial administration of endothelium-dependent (acetylcholine), endothelium-independent (sodium nitroprusside) and nitrate-independent (verapamil) vasodilators were measured using forearm plethysmography. Whole-body insulin resistance was assessed on both occasions using the homeostasis model (HOMA-IR). Subjects who received metformin demonstrated statistically significant improvement in acetylcholine-stimulated flows compared with those treated with placebo (p = 0.0027 by 2-way analysis of variance), whereas no significant effect was seen on nitroprusside-stimulated (p = 0.27) or verapamil-stimulated (p = 0.40) flows. There was a significant improvement in insulin resistance with metformin (32.5% reduction in HOMA-IR, p = 0.01), and by stepwise multivariate analysis insulin resistance was the sole predictor of endothelium-dependent blood flow following treatment (r = 0.659, p = 0.0012) Continue reading >>
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Vibrant Health Network
Why Doctors In The Know No Longer Prescribe Metformin Until recently, diabetics looking for doctor-approved, drug-free treatment options were out of luck. But a growing number of health experts believe those days are behind us. Dr. Marlene Merritt (DOM, MS Nutrition), an Austin-based doctor who used to suffer high blood sugar herself, made a recent announcement that is sending shockwaves through the medical community. Dr. Merritt knew all too well that commonly-prescribed diabetes drugs like Metformin came with a host of unwanted side effects, and was determined to find a natural, drug-free solution that could actually eliminate the disease, not just treat its symptoms. After months of research, Dr. Merritt developed a simple diet and exercise regimen that had a profound success rate in treating and even reversing type II diabetes. Despite the regimen's clear effectiveness, medical journals were slow to publish her findings, perhaps due in part, some have speculated, to financial ties to the pharmaceutical industry. In response, Dr. Merritt took matters in to her own hands and shocked the medical community by partnering with independent health publisher Primal Health to make her diabetes-reversing regimen available to everyone in the form of an online presentation. The video has already gone viral, generating a huge range of response. Several viewers have noted the simplicity of the regimen, along with how non-restrictive the diet sounds. Unsurprisingly, many in the pharmaceutical industry have taken issue with the presentation's drug-free emphasis, but many doctors who have wished for a natural, drug-free treatment to share with their diabetic patients have been quick to embrace it. Dr. Merritt herself cautions viewers to exercise common sense and only go off your med Continue reading >>
Metformin Significantly Reduces Incident Prostate Cancer Risk In Taiwanese Men With Type 2 Diabetes Mellitus - Sciencedirect
Volume 50, Issue 16 , November 2014, Pages 2831-2837 Metformin significantly reduces incident prostate cancer risk in Taiwanese men with type 2 diabetes mellitus Author links open overlay panel Chin-HsiaoTseng Whether metformin therapy affects incident prostate cancer risk in Asian patients with type 2 diabetes mellitus (T2DM) has not been investigated. The National Health Insurance reimbursement database of Taiwanese male patients with new-onset T2DM between 1998 and 2002 and aged 40years (n=395,481) were retrieved to follow up prostate cancer incidence until the end of 2009. Metformin was treated as a time-dependent variable. Of the patients studied, 209,269 were never-users and 186,212 were ever-users. A time-dependent approach was used to calculate prostate cancer incidence and estimate hazard ratios using Cox regression for ever-users, never-users and subgroups of metformin exposure (tertiles of cumulative duration and cumulative dose). Sensitivity analyses were conducted in various subgroups, using time-dependent and non-time-dependent approaches. During the follow-up, 2776 metformin ever-users and 9642 never-users developed prostate cancer, representing an incidence of 239.42 and 737.10 per 100,000 person-years, respectively. The hazard ratio (95% confidence intervals) after adjustment for propensity score (PS) for ever- versus never-users was 0.467 (0.4460.488). The PS-adjusted hazard ratios for the first, second and third tertiles of cumulative duration of metformin therapy were 0.741 (0.6980.786), 0.474 (0.4410.508) and 0.231 (0.2120.253), respectively (P-trend<0.001); and were 0.742 (0.7000.786), 0.436 (0.4060.468) and 0.228 (0.2080.251) for the respective cumulative dose (P-trend<0.001). Sensitivity analyses consistently supported a protective effect of met Continue reading >>
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- Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)*
- Eating fruit significantly cuts diabetes risk - but drinking juice INCREASES it, says study
Does Metformin Cause Weight Loss? What To Know Before You Take It
If you’re managing type 2 diabetes with metformin (Glucophage), you might be well acquainted with unwanted side effects of this drug — namely, upset stomach, diarrhea, muscle aches, and sleepiness. These can be a figurative and literal pain, but you might welcome one side effect of metformin with open arms, particularly if you’ve struggled to lose weight. Metformin isn’t a weight loss drug, but researchers have found a link between the drug and weight loss. In fact, a long-term study published in April 2012 in the journal Diabetes Care that was conducted by the Diabetes Prevention Program (DPP) concluded that the drug could serve as a treatment for excess body weight, although more studies are needed. What Is Metformin and How Does It Work? “[Metformin] has been considered a first-line medication in the treatment of type 2 diabetes, and it mainly acts by lowering the amount of glucose released by the liver,” says Minisha Sood, MD, an endocrinologist at Lenox Hill Hospital in New York City. “It also helps a hormone called insulin to work better by helping muscles use glucose in a more efficient manner. When insulin works better (and insulin sensitivity improves), a person’s insulin levels are lower than they would be otherwise.” There’s no cure for type 2 diabetes, but the right combination of medication and healthy lifestyle can stabilize blood sugar levels, which, of course, is the end goal of any diabetes treatment. As the medication helps your body properly metabolize food and restores your ability to respond to insulin, you’ll not only feel better, you can potentially avoid complications of high blood sugar, such as heart disease, kidney damage, nerve damage (diabetic neuropathy), and eye damage (retinopathy). Why Does Metformin Cause Weight Lo Continue reading >>
Metformin - Oral, Glucophage
are allergic to dapagliflozin or any of the ingredients in FARXIGA. Symptoms of a serious allergic reaction may include skin rash, raised red patches on your skin (hives), swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing. If you have any of these symptoms, stop taking FARXIGA and contact your healthcare provider or go to the nearest hospital emergency room right away 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 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 Ketoacidosis occurred in people with type 1 and type 2 diabetes during treatment with FARXIGA. Ketoacidosis is a serious condition which may require hospitalization and may lead to death. Symptoms may include nausea, tiredness, vomiting, trouble breathing, and abdominal pain. If you get any of these symptoms, stop taking FARXIGA and call your healthcare provider right away. If possible, check for ketones in your urine or blood, even if your blood sugar is less than 250 mg/dL Kidney problems. Sudden kidney injury occurred in people taking FARXIGA. Talk to your doctor right away if you reduce the amount you eat or drink, or if you lose liquids; for example, from vomiting, diarrhea, or excessive heat exposure Serious urinary tract infections (UTI), some that lead to hospitalization, occu Continue reading >>
Metformin: An Old Drug For The Treatment Of Diabetes But A New Drug For Theprotection Of The Endothelium.
1. Med Princ Pract. 2015;24(5):401-15. doi: 10.1159/000381643. Epub 2015 May 28. Metformin: An Old Drug for the Treatment of Diabetes but a New Drug for theProtection of the Endothelium. (1)Departments of Medical Education and Pharmacology, Weill Cornell Medical College in Qatar, Education City, Doha, Qatar. The anti-diabetic and oral hypoglycaemic agent metformin, first used clinicallyin 1958, is today the first choice or 'gold standard' drug for the treatment oftype 2 diabetes and polycystic ovary disease. Of particular importance for thetreatment of diabetes, metformin affords protection against diabetes-inducedvascular disease. In addition, retrospective analyses suggest that treatment withmetformin provides therapeutic benefits to patients with several forms of cancer.Despite almost 60 years of clinical use, the precise cellular mode(s) of actionof metformin remains controversial. A direct or indirect role of adenosinemonophosphate (AMP)-activated protein kinase (AMPK), the fuel gauge of the cell, has been inferred in many studies, with evidence that activation of AMPK mayresult from a mild inhibitory effect of metformin on mitochondrial complex 1,which in turn would raise AMP and activate AMPK. Discrepancies, however, between the concentrations of metformin used in in vitro studies versus therapeuticlevels suggest that caution should be applied before extending inferences derivedfrom cell-based studies to therapeutic benefits seen in patients. Conceivably,the effects, or some of them, may be at least partially independent of AMPKand/or mitochondrial respiration and reflect a direct effect of either metformin or a minor and, as yet, unidentified putative metabolite of metformin on a targetprotein(s)/signalling cascade. In this review, we critically evaluate the da Continue reading >>
Vibrant Health Network
Why Doctors In The Know No Longer Prescribe Metformin Type II Diabetes sufferers may soon be tossing their test strips, lancet needles, and prescription pills. A discovery by an Austin-based doctor may change how Type II Diabetes is treated and could even be a cure. Dr. Marlene Merritt suffered from high blood sugar for years and was determined to find a natural solution. My motivation, she says, was to cast off the shackles of the daily monitoring, the shots and pills, and the drug side effects. I wanted to live a normal life again. After two years of research and trial and error experiments, Dr. Marlene Merritt hit upon a practical diet and exercise regimen that doesnt just control Type II Diabetes but actually reverses it. While the regimen eliminates a few foods, it most importantly adds a single food that has shown to have a big impact on the disease. The announcement of her discovery has sent shockwaves through the medical community, with some progressive doctors enthusiastically embracing it, and many conventional doctors taking a wait and see approach. Within weeks of adopting her own regimen, Dr. Merritts condition completely reversed. It was just gone, and I had my life back, she says. I then prescribed this drug-free solution to my diabetic patients and, in most cases, they too saw success in a matter of weeks. Despite the regimens effectiveness, medical journals have been slow to publish her findings. And Dr. Merritt suspects the reluctance is due to the outsized influence of the pharmaceutical industry, which stands to lose billions of dollars on lost drug sales. The makers of Metformin, one of several drugs Dr. Merritts natural regimen would replace, had no comment. All diabetes drug sales are expected to reach $32 billion in 2017, according to industry a Continue reading >>
The Phantom Of Metformin-induced Lactic Acidosis In End-stage Renal Disease Patients: Time To Reconsider With Peritoneal Dialysis Treatment
1Department of Internal Medicine, Nephrology Division, King Fahd Hospital of the University, University of Dammam, Saudi Arabia 2Department of Electrical Engineering, Queens University, Kingston, Ontario, Canada Correspondence to: Abdullah K. Al-Hwiesh, King Fahd Hospital of the University, Department of Internal Medicine, Nephrology Division, Al-Khobar, Saudi Arabia. ahwiesh{at}uod.edu.sa, dralhwiesh{at}yahoo.com Objective: Metformin continues to be the safest and most widely used antidiabetic drug. In spite of its well-known benefits; metformin use in end-stage renal disease (ESRD) patients is still restricted. Little has been reported about the effect of peritoneal dialysis (PD) on metformin clearance and the phantom of lactic acidosis deprives ESRD patients from metformin therapeutic advantages. Peritoneal dialysis is probably a safeguard against lactic acidosis, and it is likely that using this drug would be feasible in this group of patients. Material and methods: The study was conducted on 83 PD patients with type 2 diabetes mellitus. All patients were on automated PD (APD). Metformin was administered in a dose of 500 1,000 mg daily. Patients were monitored for glycemic control. Plasma lactic acid and plasma metformin levels were monitored on a scheduled basis. Peritoneal fluid metformin levels were measured. In addition, the relation between plasma metformin and plasma lactate was studied. Results: Mean fasting blood sugar (FBS) was 10.9 0.5 and 7.8 0.7, and mean hemoglobin A1-C (HgA1C) was 8.2 0.8 and 6.4 1.1 at the beginning and end of the study, respectively (p < 0.001). The mean body mass index (BMI) was 29.1 4.1 and 27.3 4.5 at the beginning and at the end of the study, respectively (p < 0.001). The overall mean plasma lactate level across all blood sample Continue reading >>
- Incidence of End-Stage Renal Disease Attributed to Diabetes Among Persons with Diagnosed Diabetes United States and Puerto Rico, 20002014
- Diabetic Ketoacidosis Increases Risk of Acute Renal Failure in Pediatric Patients with Type 1 Diabetes
- Renal Handling of Ketones in Response to Sodium–Glucose Cotransporter 2 Inhibition in Patients With Type 2 Diabetes
