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When To Start Metformin

Nice Guidance - Metformin In Type 2 Diabetes - General Practice Notebook

Nice Guidance - Metformin In Type 2 Diabetes - General Practice Notebook

NICE guidance - metformin in type 2 diabetes start metformin treatment in a person who is overweight or obese (tailoring the assessment of body-weight-associated risk according to ethnic group ) and whose blood glucose is inadequately controlled by lifestyle interventions (nutrition and exercise) alone metformin should be considered as an option for first-line glucose-lowering therapy for a person who is not overweight metformin should be continued if blood glucose control remains or becomes inadequate and another oral glucose-lowering medication is added the dose of metformin should be stepped up gradually over weeks to minimise risk of gastro-intestinal (GI) side effects. Consider a trial of extended-absorption metformin tablets where GI tolerability prevents continuation of metformin therapy in adults with type 2 diabetes, review the dose of metformin if the estimated glomerular filtration rate (eGFR) is below 45 ml/minute/1.73m2: Stop metformin if the eGFR is below 30 ml/minute/1.73m2 Prescribe metformin with caution for those at risk of a sudden deterioration in kidney function and those at risk of eGFR falling below 45ml/minute/1.73m2 benefits of metformin therapy should be discussed with a person with mild to moderate liver dysfunction or cardiac impairment so that: due consideration can be given to the cardiovascular-protective effects of the drug (1) an informed decision can be made on whether to continue or stop the metformin Continue reading >>

Guideline: Diabetes Treatment Should Start With Metformin

Guideline: Diabetes Treatment Should Start With Metformin

Metformin should be the first drug of choice in oral therapy for type 2 diabetics who don't respond to diet and lifestyle changes, according to a new guideline. A second agent can be added if metformin monotherapy fails to control hyperglycemia, but there's insufficient evidence to recommend one secondary agent over another, Amir Qaseem, MD, PhD, director of clinical policy at the American College of Physicians, and colleagues wrote in the organization's new guideline for the management of type 2 diabetes, published in the Annals of Internal Medicine. "We found that most diabetes medications reduced blood sugar levels to a similar degree," Qaseem said in a statement. "However, metformin is more effective compared to other type 2 diabetes drugs in reducing blood sugar levels when used alone and in combination with other drugs." There are currently 11 classes of drugs approved for treating hyperglycemia in type 2 diabetes, the researchers wrote, and most patients receive more than one class of diabetes medication. To determine the optimal treatment strategy with these agents, Qaseem and colleagues conducted a comparative safety and effectiveness analysis of studies published between 1966 and April 2010. All three recommendations in the guideline are strong and based on high-quality evidence, they said. First among the guidelines: Put patients on oral therapy when diet, exercise, and weight loss have failed to control hyperglycemia. There are no data as to the best time start oral therapy; instead, clinicians should take into account other complicating factors including life expectancy, microvascular and macrovascular complications, risk for adverse events related to glucose control, and patient preference, they wrote. The patient's HbA1c target should also be based on an Continue reading >>

Proper Use

Proper Use

Drug information provided by: Micromedex This medicine usually comes with a patient information insert. Read the information carefully and make sure you understand it before taking this medicine. If you have any questions, ask your doctor. Carefully follow the special meal plan your doctor gave you. This is a very important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed. Metformin should be taken with meals to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment. Swallow the extended-release tablet whole with a full glass of water. Do not crush, break, or chew it. While taking the extended-release tablet, part of the tablet may pass into your stool after your body has absorbed the medicine. This is normal and nothing to worry about. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way. You may notice improvement in your blood glucose control in 1 to 2 weeks, but the full effect of blood glucose control may take up to 2 to 3 months. Ask your doctor if you have any questions about this. Dosing The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the Continue reading >>

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Both the prevalence and incidence of type 2 diabetes are increasing worldwide in conjunction with increased Westernization of the population's lifestyle. Type 2 diabetes is still a leading cause of cardiovascular disease (CVD), amputation, renal failure, and blindness. The risk for microvascular complications is related to overall glycemic burden over time as measured by A1C (1,2). The UK Prospective Diabetes Study (UKPDS) 10-year follow-up demonstrated a possible effect on CVD as well (3). A meta-analysis of cardiovascular outcome in patients with long disease duration including Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) suggested that in these populations the reduction of ~1% in A1C is associated with a 15% relative reduction in nonfatal myocardial infarction (4). Most antihyperglycemic drugs besides insulin reduce A1C values to similar levels (5) but differ in their safety elements and pathophysiological effect. Thus, there is a need for recommending a drug therapy preference. While the positive effects on prevention of microvascular complications were demonstrated with the various antihyperglycemic drugs (1,2,6,7), several questions are left open regarding this therapy in newly diagnosed type 2 diabetes: What is the comparative effectiveness of antihyperglycemic drugs on other long-term outcomes, i.e., β-cell function and cardiovascular morbidity and mortality? What is the comparative safety of these treatments, and do they differ across subgroups of adults with type 2 diabetes? Should we combine antihyperglycemic drugs at the time of diagnosis according to their pathophysiological effect to address the diff Continue reading >>

Treating Prediabetes With Metformin

Treating Prediabetes With Metformin

Go to: Abstract To determine if the use of metformin in people with prediabetes (impaired glucose tolerance or impaired fasting glucose) would prevent or delay the onset of frank type 2 diabetes mellitus. MEDLINE was searched from January 1966 to the present, and articles meeting the selection criteria were hand searched. Randomized controlled trials that involved administration of metformin to delay or prevent type 2 diabetes in individuals with impaired glucose tolerance or impaired fasting glucose were included. Development of diabetes was a required outcome measure; follow-up time of at least 6 months was required. Three studies met these criteria. The 3 studies varied in ethnicity of the population studied, in the rates of conversion to diabetes from prediabetes, and in the dose of metformin used. In general the studies were well done, although 2 of the 3 did not do true intention-to-treat analyses. A sensitivity analysis was completed by converting all data to intention-to-treat data and assuming a worst-case scenario for the people who were lost to follow-up. Metformin decreases the rate of conversion from prediabetes to diabetes. This was true at higher dosage (850 mg twice daily) and lower dosage (250 mg twice or 3 times daily); in people of varied ethnicity; and even when a sensitivity analysis was applied to the data. The number needed to treat was between 7 and 14 for treatment over a 3-year period. Summary of results from reviewed trials: Development of diabetes outcomes. STUDY OUTCOME EER n/N (%) CER n/N (%) RRR % (95% CI) ARR % (95% CI) NNT N (95% CI) YATES CORRECTED P VALUE COMMENTS Li et al,22 1999 (Primary analysis of 70 participants) Development of diabetes at 12 mo 1/33 (3.0) 6/37 (16.2) 81.3 (−9.5 to 97.0) 13.2 (−0.9 to 17.9) 7.6 (5.5 to infinit Continue reading >>

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

INTRODUCTION Two classes of oral hypoglycemic drugs directly improve insulin action: biguanides (only metformin is currently available) and thiazolidinediones (TZDs). In the absence of contraindications, metformin is considered the first choice for oral treatment of type 2 diabetes (table 1). A 2006 consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), updated regularly, proposed that metformin therapy (in the absence of contraindications) be initiated, concurrent with lifestyle intervention, at the time of diabetes diagnosis [1-3]. The pharmacology, efficacy, and side effects of metformin for the treatment of diabetes will be reviewed here. A general discussion of initial treatment of type 2 diabetes and the role of metformin in the prevention of diabetes, in the treatment of polycystic ovary syndrome, and in gestational diabetes are reviewed separately. Continue reading >>

Is Starting Metformin Early A Good Thing?

Is Starting Metformin Early A Good Thing?

Is starting Metformin early a good thing? When I was diagnosed T2 last month I was determined to use diet and exercise to keep it under 140 at all times. I was diagnosed early - my A1C was only 5.7 to start. My stated goal was to stay off all medications for as long as possible or forever whichever came first. It seemed like that was the right goal. I've cut carbs to almost none and I'm trying to get the exercise thing going (yeah, right). And it worked - I haven't been over 135 in 4 weeks and fasting is 94-110. Then I read this: Last week I had a Dr. appointment and he suggeseted starting Metformin right away. He agrees with the study that an early start extends the time the Metformin is effective. He feels that regardless of how well you can control BS making your body do it alone makes your body work too hard. And that waiting until you can't control it to start Met makes the Met work too hard but using both working together at the start gives both the chance to work their best and for a longer period of time. So... based on the study and Doc's advice... I started 500mg Met on Sunday. At 4 days I'm doing fine with it - no digestive upset at all, but I swear it makes me incredibly sleepy in the afternoon. Anyway, what does everyone think about this - do you think starting Met early is a good thing? I agree as well, metformin can cause stomack and intestinal problems. I have been put on it recently, but have not had any problems on the extended release form. Endo had been wanting me to go on Byetta which I refused, and when I mentioned the idea of metformin to reduce insulin resistence, she jumped on it as this will also help me reduce my desire for food and be able to lose the weight I need to lose. You did not mention which form of metformin you are taking, but if y Continue reading >>

About Metformin

About Metformin

Metformin is a medicine used to treat type 2 diabetes and sometimes polycystic ovary syndrome (PCOS). Type 2 diabetes is an illness where the body doesn't make enough insulin, or the insulin that it makes doesn't work properly. This can cause high blood sugar levels (hyperglycemia). PCOS is a condition that affects how the ovaries work. Metformin lowers your blood sugar levels by improving the way your body handles insulin. It's usually prescribed for diabetes when diet and exercise alone have not been enough to control your blood sugar levels. For women with PCOS, metformin stimulates ovulation even if they don't have diabetes. It does this by lowering insulin and blood sugar levels. Metformin is available on prescription as tablets and as a liquid that you drink. Key facts Metformin works by reducing the amount of sugar your liver releases into your blood. It also makes your body respond better to insulin. Insulin is the hormone that controls the level of sugar in your blood. It's best to take metformin with a meal to reduce the side effects. The most common side effects are feeling sick, vomiting, diarrhoea, stomach ache and going off your food. Metformin does not cause weight gain (unlike some other diabetes medicines). Metformin may also be called by the brand names Bolamyn, Diagemet, Glucient, Glucophage, and Metabet. Who can and can't take metformin Metformin can be taken by adults. It can also be taken by children from 10 years of age on the advice of a doctor. Metformin isn't suitable for some people. Tell your doctor before starting the medicine if you: have had an allergic reaction to metformin or other medicines in the past have uncontrolled diabetes have liver or kidney problems have a severe infection are being treated for heart failure or you have recentl Continue reading >>

A Comprehensive Guide To Metformin

A Comprehensive Guide To Metformin

Metformin is the top of the line medication option for Pre-Diabetes and Type 2 Diabetes. If you must start taking medication for your newly diagnosed condition, it is then likely that your healthcare provider will prescribe this medication. Taking care of beta cells is an important thing. If you help to shield them from demise, they will keep your blood sugar down. This medication is important for your beta cell safety if you have Type 2 Diabetes. Not only does Metformin lower blood sugar and decrease resistance of insulin at the cellular level, it improves cell functioning, lipids, and how fat is distributed in our bodies. Increasing evidence in research points to Metformin’s effects on decreasing the replication of cancer cells, and providing a protective action for the neurological system. Let’s find out why Lori didn’t want to take Metformin. After learning about the benefits of going on Metformin, she changed her mind. Lori’s Story Lori came in worrying. Her doctor had placed her on Metformin, but she didn’t want to get the prescription filled. “I don’t want to go on diabetes medicine,” said Lori. “If I go on pills, next it will be shots. I don’t want to end up like my dad who took four shots a day.” “The doctor wants you on Metformin now to protect cells in your pancreas, so they can make more insulin. With diet and exercise, at your age, you can reverse the diagnosis. Would you like to talk about how we can work together to accomplish that?” “Reverse?” she asked. “What do you mean reverse? Will I not have Type 2 Diabetes anymore?” “You will always have it, but if you want to put it in remission, you are certainly young enough to do so. Your doctor wants to protect your beta cells in the pancreas. If you take the new medication, Continue reading >>

10 Things You Should Know

10 Things You Should Know

View as slideshow Metformin is a Workhorse for Type 2 Diabetes Metformin, also known by the brand names Glucophage, Glucophage XR, Fortamet, and others, has been available for the oral treatment of type 2 diabetes since 1995. Metformin helps to control blood sugar (glucose) levels and is sometimes used in combination with insulin or other medications. Metformin is a true workhorse for diabetics: a study in JAMA Internal Medicine showed that people newly diagnosed with type 2 diabetes who were initially started on metformin were less likely to need other diabetic drug treatments to control their blood sugar. In fact, metformin is recommended in guidelines as the first-line drug treatment for new patients. Metformin is Truly Lifesaving We know that starting type 2 diabetes treatment with metformin helps to prevent the need for additional diabetes medications in the long-term. But what else does it do? A study from the Annals of Internal Medicine demonstrated that starting diabetes treatment with metformin is also linked with a lower long-term risk of heart attack, stroke, and death than starting with a sulfonylurea, like glyburide or glipizide. However, researchers can't say whether the difference is due to extra risk from sulfonylurea drugs, added benefits from metformin, or both. Diabetes is Expensive but Metformin is Affordable A generic form of both regular-release and extended-release metformin is available at your pharmacy. However, prices will vary from city to city, and even pharmacy to pharmacy. There are several different strengths of metformin, too. It may be that instead of taking the 1,000 mg (1 gram) tablet of metformin per dose you could take two 500 mg tablets and save money. Always ask for the least costly version of generic metformin, as some generics ma Continue reading >>

Management Of Blood Glucose With Noninsulin Therapies In Type 2 Diabetes

Management Of Blood Glucose With Noninsulin Therapies In Type 2 Diabetes

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

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 >>

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Guideline Approach To Therapy In Patients With Newly Diagnosed Type 2 Diabetes

Both the prevalence and incidence of type 2 diabetes are increasing worldwide in conjunction with increased Westernization of the population's lifestyle. Type 2 diabetes is still a leading cause of cardiovascular disease (CVD), amputation, renal failure, and blindness. The risk for microvascular complications is related to overall glycemic burden over time as measured by A1C (1,2). The UK Prospective Diabetes Study (UKPDS) 10-year follow-up demonstrated a possible effect on CVD as well (3). A meta-analysis of cardiovascular outcome in patients with long disease duration including Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) suggested that in these populations the reduction of ~1% in A1C is associated with a 15% relative reduction in nonfatal myocardial infarction (4). Most antihyperglycemic drugs besides insulin reduce A1C values to similar levels (5) but differ in their safety elements and pathophysiological effect. Thus, there is a need for recommending a drug therapy preference. While the positive effects on prevention of microvascular complications were demonstrated with the various antihyperglycemic drugs (1,2,6,7), several questions are left open regarding this therapy in newly diagnosed type 2 diabetes: What is the comparative effectiveness of antihyperglycemic drugs on other long-term outcomes, i.e., β-cell function and cardiovascular morbidity and mortality? What is the comparative safety of these treatments, and do they differ across subgroups of adults with type 2 diabetes? Should we combine antihyperglycemic drugs at the time of diagnosis according to their pathophysiological effect to address the diff 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 >>

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 >>

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