The Effect Of Metformin On Survival Of Patients With Pancreatic Cancer: A Meta-analysis
The effect of metformin on survival of patients with pancreatic cancer: a meta-analysis Scientific Reportsvolume7, Articlenumber:5825 (2017) We conducted a meta-analysis to analyse the effect of metformin on survival of pancreatic cancer patients at various stages. We performed a systematic search of PubMed, Embase, Cochrane, and Web of Science to identify all relevant studies. Summary hazard ratios (HR) of survival and 95% confidence intervals (95% CI) were calculated with a fixed or random effects model according to inter-study heterogeneity. Nine retrospective cohort studies and two randomized controlled trials (RCTs) were eligible. There was a significant improvement in survival (HR = 0.86, 95% CI 0.760.97; P < 0.05) in the metformin group compared with control. Subgroup analysis indicated that metformin improved survival in patients with resection (HR = 0.79, 95% CI 0.690.91; P < 0.05) and patients with locally advanced tumors (HR = 0.68, 95% CI 0.550.84; P < 0.05) but not in patients with metastatic tumors, even when RCT data were included (HR = 0.99, 95% CI 0.701.40; P > 0.05), or were excluded (HR = 0.89, 95% CI 0.611.31; P > 0.05). This meta-analysis indicated that the effect of metformin does correlate with tumor stage but should be prudently considered given the limited and variable studies performed to data. Pancreatic cancer is among the most lethal of malignancies 1 , 2 , 3 , 4 . Each year, 53,000 new cases are diagnosed with this disease, which leads to approximately 42,000 deaths annually in the United States 5 . Limited advances have been made regarding treatment developments and the disease prognosis remains poor, with the 5-year overall survival rate ranging from 36% with a median survival of < six months 6 , 7 , 8 , 9 . Even in patients at early sta Continue reading >>
Diabetes Drug Metformin May Lower Risk Of Pancreatic Cancer For Women
Diabetes Drug Metformin May Lower Risk of Pancreatic Cancer for Women By Sarah C.P. Williams, MyHealthNewsDaily Contributor | Increasing evidence is suggesting that Type 2 diabetes and pancreatic cancer are somehow linked, but exactly how the link works remains unclear. A new study may help clarify things it shows that taking a drug aimed at treating Type 2 diabetes may change a person's risk of developing pancreatic cancer, depending on the drug. Though some research has shown those with Type 2 diabetes are at an increased risk of developing pancreatic cancer, the new study found that women who took metformin, now the most common treatment for Type 2 diabetes, had a lower risk of pancreatic cancer than the general population. In contrast, women who took drugs from an older class of diabetes treatments, called sulfonylureas, had a higher risk of the cancer, according to the study. For men, insulin use was linked with a slightly increased risk of pancreatic cancer. The gender differences surprised the scientists at the University of Basel in Switzerland, who conducted the research. "This result is somewhat unexpected, and could not be explained by confounding use of estrogens," they wrote in the paper, which was published Jan. 31 in the American Journal of Gastroenterology. Previous, smaller studies have found decreased risk of pancreatic cancer in people taking metformin, but the results of those studies did not consider the genders separately. About 26 million people in the U.S. have Type 2 diabetes, and that number could double or even triple over the coming decades, according to the Centers for Disease Control and Prevention. Previous work has reported an overall increased risk of pancreatic cancer in diabetes patients, and researchers have suggested that, among ris Continue reading >>
Metformin Induced Acute Pancreatitis Precipitated By Renal Failure
A 61 year old woman presented to the emergency department with a history of vomiting for four days and abdominal pain for one day. Her medical history included type 2 diabetes, ischaemic heart disease, and previous myocardial infarction, and regular medications included aspirin, atenolol, clopidogrel, amlodipine, lisinopril, nitrate, metformin, nateglinide, and ibuprofen. Owing to vomiting, she had stopped taking most of her medications except the antidiabetic drugs. On clinical examination she looked dry and afebrile, and her initial blood pressure was 110/50 mm Hg, her pulse rate was 50 beats/min and regular, and she had an oxygen saturation of 98% on 2 l of oxygen. Abdominal examination revealed epigastric tenderness without guarding or rigidity. Blood tests showed haemoglobin of 129 g/l, a white cell count of 11.8 × 109/l, urea of 28.8 mmol/l, creatinine of 516 umol/l, sodium of 145 mmol/l, potassium of 6.7 mmol/l, chloride of 95 mmol/l, glucose of 9 mmol/l, and lactate of 25 mmol/l. Arterial blood gases showed a pH of 7.0 and an anion gap of 43 mmol/l. A liver function test was grossly normal. Amylase was raised at 250 U/l, and this subsequently increased to 769 U/l. Computed tomography of the abdomen was suggestive of pancreatitis. Her renal function had been checked one month previously and had been normal, and her glycated haemoglobin was 5.9%. She deteriorated further in the emergency department, with blood pressure dropping to 65/50 mm Hg and a urine output of less than 5 ml/hour. Bicarbonate infusion did not improve her acidosis. She was transferred to the intensive care unit and treated with intravenous fluids, ionotrope, insulin, and haemodialysis with bicarbonate buffered replacement fluid. All medications were discontinued. Lactic acidosis resolved follo Continue reading >>
Frontiers | Diabetes, Pancreatic Cancer, And Metformin Therapy | Physiology
Front. Physiol., 07 November 2014 | Diabetes, pancreatic cancer, and metformin therapy 1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA 2Department of Medicine, Veterans Affairs, Los Angeles, CA, USA 3Cancer Prevention and Genetics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 4Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA Pancreatic cancer carries a poor prognosis as most patients present with advanced disease and preferred chemotherapy regimens offer only modest effects on survival. Risk factors include smoking, obesity, heavy alcohol, and chronic pancreatitis. Pancreatic cancer has a complex relationship with diabetes, as diabetes can be both a risk factor for pancreatic cancer and a result of pancreatic cancer. Insulin, insulin-like growth factor-1 (IGF-1), and certain hormones play an important role in promoting neoplasia in diabetics. Metformin appears to reduce risk for pancreatic cancer and improve survival in diabetics with pancreatic cancer primarily by decreasing insulin/IGF signaling, disrupting mitochondrial respiration, and inhibiting the mammalian target of rapamycin (mTOR) pathway. Other potential anti-tumorigenic effects of metformin include the ability to downregulate specificity protein transcription factors and associated genes, alter microRNAs, decrease cancer stem cell proliferation, and reduce DNA damage and inflammation. Here, we review the most recent knowledge on risk factors and treatment of pancreatic cancer and the relationship between diabetes, pancreatic cancer, and metformin as a potential therapy. Pancreatic cancer is the twelfth most common cancer in the US but represents the fourth leading Continue reading >>
Description And Brand Names
Drug information provided by: Micromedex US Brand Name Fortamet Glucophage Glucophage XR Glumetza Riomet Descriptions Metformin is used to treat high blood sugar levels that are caused by a type of diabetes mellitus or sugar diabetes called type 2 diabetes. With this type of diabetes, insulin produced by the pancreas is not able to get sugar into the cells of the body where it can work properly. Using metformin alone, with a type of oral antidiabetic medicine called a sulfonylurea, or with insulin, will help to lower blood sugar when it is too high and help restore the way you use food to make energy. Many people can control type 2 diabetes with diet and exercise. Following a specially planned diet and exercise will always be important when you have diabetes, even when you are taking medicines. To work properly, the amount of metformin you take must be balanced against the amount and type of food you eat and the amount of exercise you do. If you change your diet or exercise, you will want to test your blood sugar to find out if it is too low. Your doctor will teach you what to do if this happens. Metformin does not help patients does not help patients who have insulin-dependent or type 1 diabetes because they cannot produce insulin from their pancreas gland. Their blood glucose is best controlled by insulin injections. This medicine is available only with your doctor's prescription. This product is available in the following dosage forms: Tablet Tablet, Extended Release Solution Copyright © 2017 Truven Health Analytics Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Continue reading >>
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Popular Diabetes Treatment Could Trigger Pancreatitis, Pancreatic Cancer, Study Suggests
Follow all of ScienceDaily's latest research news and top science headlines ! Popular Diabetes Treatment Could Trigger Pancreatitis, Pancreatic Cancer, Study Suggests A drug widely used to treat type 2 diabetes may have unintended effects on the pancreas that could lead to a form of low-grade pancreatitis in some patients and a greater risk of pancreatic cancer in long-term users. Sitagliptin, sold in pill form as Januvia, caused abnormalities in the pancreas that are recognized as risk factors for pancreatitis and, with time, pancreatic cancer in humans. A drug widely used to treat Type 2 diabetes may have unintended effects on the pancreas that could lead to a form of low-grade pancreatitis in some patients and a greater risk of pancreatic cancer in long-term users, UCLA researchers have found. Researchers from the Larry L. Hillblom Islet Research Center at UCLA found that sitagliptin, sold in pill form as Januvia, caused abnormalities in the pancreas that are recognized as risk factors for pancreatitis and, with time, pancreatic cancer in humans. Januvia is marketed by Merck & Co. Inc. Sitagliptin is a member of a new class of drugs that enhance the actions of the gut hormone known as glucagon-like peptide 1 (GLP-1), which has been shown to be effective in lowering blood sugar in people with Type 2 diabetes. "Type 2 diabetes is a lifelong disease people often take the same drugs for many years, so any adverse effect that could over time increase the risk for pancreatic cancer would be a concern," said Dr. Peter Butler, director of the Hillblom Center and the study's lead investigator. "A concern here is that the unwanted effects of this drug on the pancreas would likely not be detected in humans unless the pancreas was removed and examined." An observed connection b Continue reading >>
Diabetes Drugs Tied To Pancreatic Cancer Risk
NEW YORK (Reuters Health) - A new study links the diabetes drug metformin to fewer cases of pancreatic cancer -- at least in women -- but finds other diabetes medications are associated with a higher risk of the disease. The differences in medication history among people who did or didn’t get pancreatic cancer were small, researchers said, and it’s unclear why the drugs might affect cancer risks in men and women differently. Still, the new finding is in line with previous research suggesting that metformin may decrease the risk of multiple cancers, said Dr. Peter Butler, a diabetes researcher at the University of California, Los Angeles David Geffen School of Medicine, who wasn’t involved in the new study. “One theme that seems to be coming through... is that the oldest drug we have for diabetes, metformin, is undoubtedly the best drug we have for diabetes,” he told Reuters Health. Pancreatic cancer is relatively rare as far as cancers go, but progresses quickly; most people don’t survive more than a couple years after diagnosis. The National Cancer Institute estimates that about 44,000 people will be diagnosed with pancreatic cancer in the United States this year, and close to 38,000 will die from the disease. Research has suggested that people with pancreatic cancer may have an increased risk of diabetes, but it’s unclear how diabetes -- and the drugs used to treat it -- may affect pancreatic cancer risks in previously cancer-free people. To help answer that question, Dr. Christoph Meier of the University Hospital Basel in Switzerland and his colleagues consulted a database of more than eight million people in the UK, including about 2,800 who were diagnosed with pancreatic cancer between 1995 and 2009. For each of those people, they found another six of Continue reading >>
Metformin Induced Acute Pancreatitis And Lactic Acidosis In A Patient On Hemodialysis
Your browser does not support the NLM PubReader view. Go to this page to see a list of supporting browsers. Metformin induced acute pancreatitis and lactic acidosis in a patient on hemodialysis Yeungnam Univ J Med. 2016 Jun;33(1):33-36. Yeungnam Univ J Med. 2016 Jun;33(1):33-36. Korean. Published online June 30, 2016. Copyright 2016 Yeungnam University College of Medicine Metformin induced acute pancreatitis and lactic acidosis in a patient on hemodialysis Yeon-Kyung Lee,Kihyun Lim,Su-Hyun Hwang,Young-Hwan Ahn,Gyu-Tae Shin,Heungsoo Kim and In-Whee Park Department of Nephrology, Ajou University School of Medicine, Suwon, Korea. Corresponding Author: In-Whee Park, Department of Nephrology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea. Tel: +82-31-219-5131, Fax: +82-31-219-5987, Email: [email protected] Received October 16, 2014; Revised February 13, 2015; Accepted February 13, 2015. Metformin, commonly prescribed for type 2 diabetes, is considered safe with minimal side-effect. Acute pancreatitis is rare but potentially fatal adverse side-effect of metformin. We report a patient on hemodialysis with metformin-related acute pancreatitis and lactic acidosis. A 62-year-old woman with diabetic nephropathy and hypertension presented with nausea and vomiting for a few weeks, followed by epigastric pain. At home, the therapy of 500 mg/day metformin and 50 mg/day sitagliptin was continued, despite symptoms. Laboratory investigations showed metabolic acidosis with high levels of lactate, amylase at 520 U/L (range, 30-110 U/L), and lipase at 1,250 U/L (range, 23-300 U/L). Acute pancreatitis was confirmed by computed tomography. No recognized cause of acute pancreatitis was identified. Metformin was discontinued. Treatment with insulin and in Continue reading >>
Possible Medication Induced Pancreatitis?
Hi all, I'm new here. So, about 4 years ago I was diagnosed with polycystic ovarian syndrome, and educated to lose 50 pounds, and I was put on metformin for insulin resistance. About 6 months after starting metformin, I began having random pains in my mid chest, right under my sternum that would radiate around my right side, up my esophagus and into my right jaw, and pierce through my back. I let this pain go on for about 2 years because it would only last a few days. About 2 years ago, I got sick of it, decided it was my gallbladder and had that removed. I felt great for about 9 months, then I had all the same symptoms come back, and I thought this cant be, I had my gallbladder out... why in the eff do I feel this pain again. Once again, it lasted about 4 days, I wouldnt eat anything then the pain would go away. I went to the doctor, drew some labs, had an ultrasound, upper endoscopy...the works. They decided I must be having esophogeal spasms. SO... I have had about 4 attacks since then, they all last for about 3-5 days and as long as I dont eat or drink carbonated things I'm ok. This last one started 4 days ago, and it dawned on me that I am horribly nauseated and have pain that goes onto the left and right side now, and have nasty loose stools that are bright yellow. I'm also very, very tender under my sternum and along my bottom left rib cage (not to mention fatigued). Holy crap, maybe I have pancreatitis. I am a nurse, and I dont know why it took me so long to realize that! *worlds worst patient right here* Anyways, I got to researching about how different medications can cause pancreatititis, and I ran into a few articles on how people developed pancreatitits due to taking metformin because it overstimulates the pancreas. I rarely drink (maybe a few drinks 1-2 t Continue reading >>
Metformin Induced Acute Pancreatitis
Go to: Case Report Nineteen year-old-man, known case of Type 2 Diabetes mellitus for 4 y on 1 g metformin twice daily since diagnosis of his diabetes. He was in his usual state of health till he presented to the emergency department reporting nausea, vomiting and epigastric pain for 3 d. On physical examination, his height was 170 cm and body weight 99 kg; body mass index (BMI) 34.3 kg/m2, looked mildly dehydrated. Vitals signs were stable. Systemic examination was unremarkable, apart from mild epigastric tenderness. Laboratory investigations showed HbA1c 7.7%, Creatinine 58 µmol/L, Amylase 462 units/l (normal range < 100), Lipase 1378 units/l (0–60), white blood cells 16.8/mm3 (4–11) 80% of which was neutrophils, CRP 258 mg/l (0–5), Mg 0.76 mmol/l (0.7–1.05), Ca 2.17 mmol/l (2.2–2.6), AST 18 units/l (< 39), ALT 34 units/l (< 41), TG 0.95 mmol/l (< 2.3), Lactate 1.4 mmol/l (0.5–1.6). Abdominal Ultrasound and ERCP were done for the patient, results showed no gallstones and clear biliary tract, respectively. CT confirmed the diagnosis of acute pancreatitis, with no identifiable cause. The patient was admitted to ICU for close monitoring and further investigation. Normalization of Amylase and Lipase was reached after Metformin cessation, and Supportive treatment in the form of IV insulin and IV fluids. Other potential causes of pancreatitis were excluded. Patient was discharged home in stable condition after 2 weeks. Few days later, after re-exposure to Metformin, he presented with recurrence of his previous symptoms, and elevation of Amylase and Lipase was documented. As a result, Metformin was suspended with improvement of his symptoms and biochemical profile. Continue reading >>
In The Clinic: Metformin And Pancreatic Cancer
In the Clinic: Metformin and Pancreatic Cancer In the Clinic: Metformin and Pancreatic Cancer Metformin, traditionally used as a first-line treatment for type 2 diabetes, may be able to reduce a potential source of energy for certain cancer cells. By reducing blood glucose and improving insulin sensitivity, metformin, an oral medication that has traditionally been used as a first-line treatment for patients with type 2 diabetes, may be able to reduce a potential source of energy for certain cancer cells that express insulin receptors and require oxidative phosphorylation to replicate. Pancreatic cancer represents one such cancer that may significantly use oxidative phosphorylation, which has been observed in laboratory models.1 Metformin is a member of the biguanide family of medications that work through several molecular pathways including AMP-activated protein kinase, respiratory chain complex, and oxidative phosphorylation. With respect to diabetes, metformin uses its pathways to reduce glucose production from the liver and absorption in the small bowel along with increasing insulin sensitivity. Mixed results with respect to the use of metformin in pancreatic cancer have been reported in retrospective epidemiological studies. Sadeghi and colleagues retrospectively evaluated approximately 300 patients with both diabetes and pancreatic cancer.2 Patients who received metformin had longer 2-year survival rates (30.1% vs 15.4%; P = .004) and lower risk of death (HR, 0.68; 95% CI, 0.52 - 0.89; P = .004) compared to those who did not receive metformin. However, these results were significant only in patients without metastatic disease. Continue reading >>
How Much Do You Know About Metformin?
Metformin is a drug commonly used in the treatment of Type 2 diabetes. It is sold as a generic and under several brand names, including Glucophage, Glumetza, Riomet, and Fortamet. Both the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) recommend metformin as a cornerstone of therapy for Type 2 diabetes when exercise and dietary changes aren’t enough to keep blood glucose levels in target range. The low cost of the generic forms along with a long history of use make it a good choice for many individuals with Type 2 diabetes. Although metformin has helped many people lower their blood glucose levels, it does have some potential side effects that are worth knowing about. Understanding the risks and benefits of metformin is key to using it successfully. Take this quiz to test your knowledge of this popular diabetes medicine. (You can find the answers later in the article.) Q 1. How does metformin work to lower blood glucose levels? A. It stimulates the pancreas to make more insulin. B. It decreases the amount of glucose produced by the liver and makes it easier for cells to accept glucose from the bloodstream. C. It slows the digestive system’s breakdown of carbohydrates into glucose, allowing more time for insulin to work. D. It suppresses appetite, slows stomach emptying, and inhibits the release of glucagon (a hormone that raises blood glucose levels). 2. In addition to lowering blood glucose, metformin sometimes causes moderate weight loss. TRUE FALSE 3. In research studies, metformin use was associated with which of the following benefits in people with Type 2 diabetes? A. Reduced risk of morning high blood glucose. B. Reduced neuropathy (nerve damage). C. Reduced retinopathy (damage to the retina, a membrane in Continue reading >>
New Information On How Metformin Works
Not only has new research told us how metformin really works, but a new biomarker was found that can determine the optimal dose of metformin that should be used to get the best results for each patient. Research from the Johns Hopkins Children’s Center reveals that the drug most commonly used in Type 2 diabetics who don’t need insulin works on a much more basic level than once thought, treating persistently elevated blood sugar — the hallmark of Type 2 diabetes — by regulating the genes that control its production. investigators say they have zeroed in on a specific segment of a protein called CBP made by the genetic switches involved in overproduction of glucose by the liver that could present new targets for drug therapy of the disease. In healthy people, the liver produces glucose during fasting to maintain normal levels of cell energy production. After people eat, the pancreas releases insulin, the hormone responsible for glucose absorption. Once insulin is released, the liver should turn down or turn off its glucose production, but in people with Type 2 diabetes, the liver fails to sense insulin and continues to make glucose. The condition, known as insulin resistance, is caused by a glitch in the communication between liver and pancreas. Metformin, introduced as frontline therapy for uncomplicated Type 2 diabetes in the 1950s, up until now was believed to work by making the liver more sensitive to insulin. The Hopkins study shows, however, that metformin bypasses the stumbling block in communication and works directly in the liver cells. Senior investigator, Fred Wondisford, M.D., who heads the metabolism division at Hopkins Children’s, tells us that, "Rather than an interpreter of insulin-liver communication, metformin takes over as the messenger itself Continue reading >>
Metformin And Pancreatitis | Diabetic Connect
I was misdiagnosed with type 2 diabetes and prescribed metformin. 4 days after starting the prescription I ended up in hospital fighting for my life with pancreatitis. Doctor should have advised me not to eat or drink after midnight before taking the test. I've had 3 other Doctors agree I never had type 2 diabetes. Now the tail of my pancreas is necrotic. They are trying to say it wasn't the metformin, but when I drank alcohol 25yrs earlier was the cause. I call B.S. can't get a real diagnosis of reason I got pancreatitis. Then I read this article, any help would be appreciated since my pancreas will continue to die slowly. I was diagnosed with type 2 diabetes in 2009. I was started on 500 mg Metformin twice daily but had a bad reaction to it so was taken off it. Five years later, a new doctor wanted me to try taking it again, this time extended release. I only took 500 mg once daily as I was afraid to approach my previous dosage for fear of the same reaction. I was on Metformin for only a year, at which time I contracted acute pancreatitis and sepsis. Was admitted to the hospital, had a seizure (presumably because of the sepsis) and I experienced cardiac arrest. My heart was restarted with CPR. I experienced kidney failure and my lungs started to fill up with fluid. Was on a respirator for several days then when they tried to extubate me. I went into cardiac arrest again. I stayed on the respirator for several more days until they were finally able to get me off it and I started to wake up and kidneys started to function again. Since that time I have been on only insulin, no oral medications of any kind. I had NONE of the risk factors for pancreatitis, except oral medications for diabetes (which IS a risk factor). But I didn't know it at the time. I just trusted the d Continue reading >>
Metformin Induced Acute Pancreatitis Precipitated By Renal Failure | Postgraduate Medical Journal
Metformin induced acute pancreatitis precipitated by renal failure Metformin induced acute pancreatitis precipitated by renal failure Correspondence to: Dr Srikumar Mallick srikumarmallickhotmail.com Metformin is a biguanide commonly used in type 2 diabetes and considered to be a safe drug with minimal side effects. Approximately 2% of cases of acute pancreatitis may be caused by drugs, but it is not a known complication of metformin therapy. To date only one case of pancreatitis has been reported in association with metformin, but that was secondary to metformin poisoning (overdose). This is the first reported case of pancreatitis caused by a therapeutic dose of metformin (although in this case renal failure precipitated the metformin toxicity). Severe lactic acidosis is a rare but life threatening complication of metformin, which occurs particularly in patients with renal failure. A 61 year old woman presented to the emergency department with a history of vomiting for four days and abdominal pain for one day. Her medical history included type 2 diabetes, ischaemic heart disease, and previous myocardial infarction, and regular medications included aspirin, atenolol, clopidogrel, amlodipine, lisinopril, nitrate, metformin, nateglinide, and ibuprofen. Owing to vomiting, she had stopped taking most of her medications except the antidiabetic drugs. On clinical examination she looked dry and afebrile, and her initial blood pressure was 110/50 mm Hg, her pulse rate was 50 beats/min and regular, and she had an oxygen saturation of 98% on 2 l of oxygen. Abdominal examination revealed epigastric tenderness without guarding or rigidity. Blood tests showed haemoglobin of 129 g/l, a white cell count of 11.8 109/l, urea of 28.8 mmol/l, creatinine of 516 umol/l, sodium of 145 mmol/ Continue reading >>
