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Metformin And Weight Loss Pcos

Role Of Metformin In The Management Of Polycystic Ovary Syndrome

Role Of Metformin In The Management Of Polycystic Ovary Syndrome

Go to: Background Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder affecting 4–12% of women [Diamanti-Kandarakis et al. 1999; Farah et al. 1999; Knochenhauer et al. 1998]. It has also been the most controversial medical condition and every aspect has received a lot of attention from the nomenclature to the management. Several descriptions of similar conditions took place in the 20th century and it was named Stein—Leventhal Syndrome in 1935 after the authors who described polycystic ovarian morphology in patients suffering from hirsutism, amenorrhoea and infertility [Leventhal, 1958; Stein and Leventhal, 1935]. PCOS was also called polycystic ‘ovarian’ syndrome implying that the primary pathology lies in or triggered by the ovary. Others have called it polycystic ovary disease (PCOD), which is the least used term for obvious reasons. Currently, PCOS refers to a disorder with a combination of reproductive and metabolic characteristics. This has evolved over time with controversy over the definition culminating in the latest consensus [ESHRE/ASRM, 2004] which instead of solving the issue created more controversy [Azziz et al. 2006]. In the European Society of Human Reproduction and Embryology/American Society of Reproductive Medicine (ESHRE/ASRM) consensus, at least two of the following features are needed to make the diagnosis; oligo/anovulation, hyperandrogenism, and polycystic features on ultrasound scan [ESHRE/ASRM, 2004]. The Androgen Excess Society, however, recommended that androgen excess should remain a constant feature of PCOS irrespective of the ovulatory status and morphological features of the ovaries [Azziz et al. 2006]. For almost three decades, PCOS has been regarded as a life course disease which besides its reproductiv Continue reading >>

Metformin And Weight Loss In Obese Women With Polycystic Ovary Syndrome: Comparison Of Doses.

Metformin And Weight Loss In Obese Women With Polycystic Ovary Syndrome: Comparison Of Doses.

Abstract CONTEXT: Metformin treatment of women with polycystic ovary syndrome (PCOS) is widespread, as determined by studies with diverse patient populations. No comparative examination of weight changes or metabolite responses to different doses has been reported. OBJECTIVE: The aim of this study was to determine whether different doses of metformin (1500 or 2550 mg/d) would have different effects on body weight, circulating hormones, markers of inflammation, and lipid profiles. DESIGN: The study included prospective cohorts randomized to two doses of metformin. SETTING: The study was performed at a university teaching hospital with patients from gynecology/endocrinology clinics. PATIENTS: The patients studied were obese (body mass index, 30 to <37 kg/m2; n = 42) and morbidly obese (body mass index, > or =37 kg/m2; n = 41) women with PCOS. INTERVENTION: Patients were randomized to two doses of metformin, and parameters were assessed after 4 and 8 months. MAIN OUTCOME MEASURES: The main outcome measures were changes in body mass, circulating hormones, markers of inflammation, and lipid profiles. RESULTS: Intention to treat analyses showed significant weight loss in both dose groups. Only the obese subgroup showed a dose relationship (1.5 and 3.6 kg in 1500- and 2550-mg groups, respectively; P = 0.04). The morbidly obese group showed similar reductions (3.9 and 3.8 kg) in both groups. Suppression of androstenedione was significant with both metformin doses, but there was no clear dose relationship. Generally, beneficial changes in lipid profiles were not related to dose. CONCLUSION: Weight loss is a feature of protracted metformin therapy in obese women with PCOS, with greater weight reduction potentially achievable with higher doses. Additional studies are required to d Continue reading >>

Pcos Weight Loss Metformin - Pubmed Result

Pcos Weight Loss Metformin - Pubmed Result

1: Tao T, Wu P, Wang Y, Liu W. Comparison of glycemic control and -cell functionin new onset T2DM patients with PCOS of metformin and saxagliptin monotherapy or combination treatment. BMC Endocr Disord. 2018 Feb 27;18(1):14. doi:10.1186/s12902-018-0243-5. PubMed PMID: 29482528; PubMed Central PMCID:PMC5828487.2: Al-Ruthia YS, Balkhi B, AlGhadeer S, Mansy W, AlSanawi H, AlGasem R, AlMutairiL, Sales I. Relationship between health literacy and body mass index among Arabwomen with polycystic ovary syndrome. Saudi Pharm J. 2017 Nov;25(7):1015-1018.doi: 10.1016/j.jsps.2017.04.003. Epub 2017 Apr 13. PubMed PMID: 29158709; PubMed Central PMCID: PMC5681313.3: Ferjan S, Janez A, Jensterle M. Dipeptidyl Peptidase-4 Inhibitor SitagliptinPrevented Weight Regain in Obese Women with Polycystic Ovary Syndrome Previously Treated with Liraglutide: A Pilot Randomized Study. Metab Syndr Relat Disord.2017 Dec;15(10):515-520. doi: 10.1089/met.2017.0095. Epub 2017 Oct 24. PubMedPMID: 29064743.4: Liu X, Zhang Y, Zheng SY, Lin R, Xie YJ, Chen H, Zheng YX, Liu E, Chen L, Yan JH, Xu W, Mai TT, Gong Y. Efficacy of exenatide on weight loss, metabolicparameters and pregnancy in overweight/obese polycystic ovary syndrome. ClinEndocrinol (Oxf). 2017 Dec;87(6):767-774. doi: 10.1111/cen.13454. Epub 2017 Sep13. PubMed PMID: 28834553.5: Ibez L, Del Ro L, Daz M, Sebastiani G, Pozo J, Lpez-Bermejo A, de ZegherF. Normalizing Ovulation Rate by Preferential Reduction of Hepato-Visceral Fat inAdolescent Girls With Polycystic Ovary Syndrome. J Adolesc Health. 2017Oct;61(4):446-453. doi: 10.1016/j.jadohealth.2017.04.010. Epub 2017 Jul 14.PubMed PMID: 28712591.6: Dawson AJ, Kilpatrick ES, Coady AM, Elshewehy AMM, Dakroury Y, Ahmed L, Atkin SL, Sathyapalan T. Endocannabinoid receptor blockade reduces alanineaminot Continue reading >>

Drug Combination Promotes Weight Loss In Polycystic Ovary Syndrome

Drug Combination Promotes Weight Loss In Polycystic Ovary Syndrome

SAN FRANCISCO-- Women with polycystic ovary syndrome, or PCOS, lost significantly more weight when they took two drugs that are traditionally used to treat diabetes, rather than either drug alone, a study from Slovenia demonstrates. The results will be presented Monday at The Endocrine Society's 95th Annual Meeting in San Francisco. PCOS is the leading cause of infertility among women. In the United States, the disorder affects approximately 5 million women, according to the U.S. Department of Health and Human Services Office of Women's Health. This translates to 1 in 10 to 20 women, overall, who are affected. The disease probably is genetic, although the exact causes are still unknown. In PCOS, the ovaries produce excessive amounts of male sex hormones, or androgens. The name of the disease derives from small cysts that form on the ovaries, which do not produce enough of the hormone that triggers ovulation. When this occurs, the ovarian follicles, which have filled with fluid in preparation for ovulation, remain as cysts when ovulation fails to take place. In addition to infertility, symptoms include excessive hair growth in areas that usually are relatively hairless; obesity; menstrual irregularity; thinning or balding hair on the scalp; prediabetes or diabetes; and anxiety or depression. Weight loss in these women leads to higher chances of conception, improved pregnancy outcomes and improved metabolic profile. Treatment varies depending upon the severity of the disease, and includes lifestyle modifications and drug therapy. Some of the same medications that are used to treat diabetes also improve PCOS symptoms. One of these medications, metformin, works by regulating the hormone insulin and by suppressing androgen activity, which, in turn, helps control blood-sugar Continue reading >>

Metformin Weight Loss – Does It Work?

Metformin Weight Loss – Does It Work?

Metformin weight loss claims are something that are often talked about by health professionals to be one of the benefits of commencing metformin therapy, but are they true? At myheart.net we’ve helped millions of people through our articles and answers. Now our authors are keeping readers up to date with cutting edge heart disease information through twitter. Follow Dr Ahmed on Twitter @MustafaAhmedMD Metformin is possibly one of the most important treatments in Type II Diabetes, so the question of metformin weight loss is of the utmost importance, as if true it could provide a means to lose weight as well as control high sugar levels found in diabetes. What is Metformin? Metformin is an oral hypoglycemic medication – meaning it reduces levels of sugar, or more specifically glucose in the blood. It is so effective that the American Diabetes Association says that unless there is a strong reason not to, metformin should be commenced at the onset of Type II Diabetes. Metformin comes in tablet form and the dose is gradually increased until the maximum dose required is achieved. How Does Metformin Work & Why Would it Cause Weight Loss? Metformin works by three major mechanisms – each of which could explain the “metformin weight loss” claims. These are: Decrease sugar production by the liver – the liver can actually make sugars from other substances, but metformin inhibits an enzyme in the pathway resulting in less sugar being released into the blood. Increase in the amount of sugar utilization in the muscles and the liver – Given that the muscles are a major “sink” for excess sugar, by driving sugar into them metformin is able to reduce the amount of sugar in the blood. Preventing the breakdown of fats (lipolysis) – this in turn reduces the amount of fatt Continue reading >>

6 Reasons Why Metformin Might Not Be Safe For Pcos

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 >>

Metformin For Pcos & Weight Loss

Metformin For Pcos & Weight Loss

Metformin is used for diabetes prevention in women with PCOS.Photo Credit: milosducati/iStock/Getty Images April Khan is a medical journalist who began writing in 2005. She has contributed to publications such as "BBC Focus." In 2012, Khan received her Doctor of Public Health from the University of Medicine and Dentistry of New Jersey. She also holds an Associate of Arts from the Art Institute of Dallas and a Master of Science in international health from University College London. Polycystic ovary syndrome, or PCOS, is a condition caused by an over-production of the luteinizing hormone from the pituitary gland. This over-production causes a hormonal imbalance in estrogen, progesterone and insulin. This results in symptoms such as facial hair growth, weight gain, infertility, ovarian cysts and type 2 diabetes. Although some women dont show these symptoms initially, their physicians may prescribe metformin as a way to prevent diabetes and some may prescribe this medication to treat symptoms of PCOS and aid in weight loss. Metformin is a medication that is usually used to treat type 2 diabetes. Metformin works by controlling the level of glucose in the blood, by minimizing the amount of glucose your blood absorbs from food and the amount your liver produces. Women with PCOS have an increased level of insulin, which puts these women at risk for developing type 2 diabetes or insulin resistance. This risk is increased if a woman with this condition becomes overweight or obese. Women with PCOS may gain weight easily due to the increased insulin level and may also find it very difficult to lose this weight. For this reason, women are usually told to go on a low-glycemic index diet, which shuns foods that cause spikes in blood insulin after consuming them. In addition to dieta Continue reading >>

Metformin, Weight Loss & Pcos – Does It Actually Work?

Metformin, Weight Loss & Pcos – Does It Actually Work?

Did you know that one of the main reasons you can't lose weight with PCOS is because of your hormones? It's true, and that's why many women (and physicians) turn to using Metformin to try and help with weight loss. But just because it works for some people doesn't mean it will necessarily work for YOU. Find out why metformin helps with weight loss, but more important what works better and how to finally lose weight if you have PCOS. ​ Insulin & PCOS: Why It's so Important One of the most common medications prescribed for PCOS is metformin. But, PCOS is a hormonal condition which results in weight gain, hair growth on the face, infertility, acne and estrogen/progesterone imbalances. So why is metformin, a medication used to lower blood sugar and treat insulin resistance, used to treat estrogen/progesterone imbalances in women? The logic is quite simple: Most of the symptoms of PCOS (all those listed above) stem from insulin resistanc e! In fact many physicians recommend that ALL women with PCOS should be treated for insulin resistance regardless of what their fasting insulin and fasting blood sugar levels are. This means that the root cause of PCOS (at least the majority of it) is insulin resistance, and this is why metformin is so commonly used to treat. Insulin resistance causes a block of glucose uptake in your skeletal muscles which results in a lower metabolism (and weight gain), insulin also directly acts on your ovaries and adrenals increasing androgens like testosterone and DHEA. It's also the action of insulin on your pituitary that results in increased LH production which over stimulates your ovaries resulting in the characteristic "cysts" of PCOS. ​ High levels of DHEA and testosterone lead to acne and hair growth (hirsutism). ​ But one simple question r Continue reading >>

Pcos Strategies: Will I Lose Weight With Metformin?

Pcos Strategies: Will I Lose Weight With Metformin?

Weight loss is important for women who are fighting Polycystic Ovarian Syndrome, or PCOS, because excess weight can cause complications that make this condition worse.1 This disorder is often accompanied by Insulin Resistance, which can lead to weight gain because it causes excess blood sugar and insulin to float through the bloodstream.1 Therefore, PCOS weight loss is an important part of improving this condition. Can Medication Contribute to Weight Loss? PCOS drugs are designed to address the core issues of the condition: Insulin Resistance and a hormonal imbalance. One of these drugs, Metformin, actually causes women to lose weight. Also known as Glucophage, this pharmaceutical promotes weight loss at a price; the side effects that are associated with this medication range from mild to severe. In an effort to lose weight, PCOS sufferers may take this drug anyway. The Risk Involved Metformin poses many risks, which commonly include:2 Increased sweating and thirst Muscle pain Fever Chills Weakness Heart palpitations Lightheadedness Dizziness Difficulty breathing Abnormal stools Nail problems Flushing (this occurs when the skin, particularly that of the face, turns red) Additional risks, such as allergic reactions, kidney and liver failure, and electrolyte disturbances, may also occur.2 While these side effects are dangerous, the benefits of the pharmaceutical sometimes outweigh the risks, depending upon individual circumstances. Losing Weight the Healthy Way Although taking Metformin can contribute to weight loss, it is not the only way in which women can shed excess pounds to improve their health. Achieving healthy, sustainable weight loss is the goal of many women who have PCOS, so losing weight in the proper manner is important. While this drug may contribute to wei Continue reading >>

Must I Increase My Dose Of Metformin To Lose Weight?

Must I Increase My Dose Of Metformin To Lose Weight?

Weight loss is an integral aspect of improving Polycystic Ovarian Syndrome, or PCOS, in women who are overweight. Carrying extra weight can cause the condition’s symptoms to become more severe, and can even increase the level of Insulin Resistance (IR) that a woman experiences.1 IR occurs when the body’s cells become desensitized to insulin, preventing the hormone from turning glucose into energy. This results in high blood sugar and, in some cases, diabetes. For this reason, Metformin, a popular diabetes medication, is also used to improve PCOS. Aside from regulating blood sugar levels, this pharmaceutical, also known as Glucophage, contributes to weight loss. How Metformin Encourages PCOS Weight Loss Insulin is a hormone that triggers both hunger and the production of fat cells. Therefore, by reducing insulin, women can reduce the amount of food they eat as well as the amount of fat cells that their bodies produce.2 Metformin’s primary function is to reduce insulin, so it is only natural that this medication contributes to weight loss. How Much Medication Is Necessary? Dosage is determined by several factors; healthcare professionals consider medical history, body type, and severity of symptoms when coming to the proper dosage. Metformin comes in three different sized pills: 500 mg, 850 mg, and 1,000 mg.2 Generally, individuals are prescribed between 850 and 1,000 mg two times per day, with 850 mg three times per day being the maximum amount of the medication safe to consume.2 Typically, doctors will prescribe a low dose to gauge the body’s reaction to the medication.2 If the body needs more, physicians will alter the dosage until the right amount is achieved. Because so many factors contribute to the proper dosage, many women who are prescribed different amou Continue reading >>

Metformin Weight Loss – How It Works, Benefits, And Side Effects

Metformin Weight Loss – How It Works, Benefits, And Side Effects

Do you find it extremely difficult to refrain from eating all the time? Have you gained too much weight? Or did your doctor just tell you that you have polycystic ovaries? If you answered “yes” to any one of these questions, chances are your body is resistant to insulin. According to the National Institute of Diabetes and Digestive and Kidney Diseases, insulin resistance can lead to diabetes type 2, prediabetes, and infertility. This can take a toll on your physical and emotional health (1). To counteract these health problems, doctors often prescribe the drug Metformin. This drug has helped many to lose weight and improve insulin sensitivity, and it can definitely help you too. So, read on to find out how Metformin can help you lose weight, the dosage, side effects, and much more. What Is Metformin? Metformin is a drug that helps to control the blood glucose levels. It is a derivative of biguanide (a group of drugs that prevent the production of glucose by the liver) that helps to improve insulin sensitivity, thereby reducing the sugar levels in the blood and the risk of diabetes type 2. It also helps regulate the amount of sugar absorbed in the intestine. Metformin was first synthesized in the 1920s. But only in 1957, it was made available in the market as an effective antidiabetic drug. It is generally sold under the brand name Glucophage and is taken orally. It is taken by people who are obese and at the risk of developing diabetes type 2 and by women who have irregular periods and are at a risk of PCOs and infertility (2). So, how does Metformin aid weight loss? Find out next. Metformin And Weight Loss – How It Works ? In obese individuals, metformin acts by suppressing the production of sugar by the liver. It reduces the rate of gluconeogenesis and glycogeno Continue reading >>

Polycystic Ovary Syndrome (pcos) And Weight Gain

Polycystic Ovary Syndrome (pcos) And Weight Gain

Most women at some point have to contend with weight gain. But for women with polycystic ovary syndrome (PCOS), losing weight can become a constant struggle. PCOS is the most common hormonal disorder in women of childbearing age and can lead to issues with fertility. Women who have PCOS have higher levels of male hormones and are also less sensitive to insulin or are "insulin-resistant." Many are overweight or obese. As a result, these women can be at a higher risk of diabetes, heart disease, sleep apnea, and uterine cancer. If you have PCOS, certain lifestyle changes can help you shed pounds and reduce the disease's severity. Why does polycystic ovary syndrome cause weight gain? PCOS makes it more difficult for the body to use the hormone insulin, which normally helps convert sugars and starches from foods into energy. This condition -- called insulin resistance -- can cause insulin and sugar -- glucose -- to build up in the bloodstream. High insulin levels increase the production of male hormones called androgens. High androgen levels lead to symptoms such as body hair growth, acne, irregular periods -- and weight gain. Because the weight gain is triggered by male hormones, it is typically in the abdomen. That is where men tend to carry weight. So, instead of having a pear shape, women with PCOS have more of an apple shape. Abdominal fat is the most dangerous kind of fat. That’s because it is associated with an increased risk of heart disease and other health conditions. What are the risks associated with PCOS-related weight gain? No matter what the cause, weight gain can be detrimental to your health. Women with PCOS are more likely to develop many of the problems associated with weight gain and insulin resistance, including: Endometrial cancer Many of these condit Continue reading >>

Polycystic Ovarian Syndrome Fertility Treatment With Metformin (glucophage)

Polycystic Ovarian Syndrome Fertility Treatment With Metformin (glucophage)

How Metformin Is Used for Polycystic Ovaries Polycystic ovarian syndrome is a common cause of anovulation and infertility in women. These women do not ovulate (release eggs) regularly and therefore have irregular menstrual periods. The ovaries have many small cysts (2-7 mm diameter) called antral follicles, giving the ovaries a characteristic "polycystic" (many cysts) appearance on ultrasound. A relatively new method of treating ovulation problems in women with polycystic ovarian disease is to use an oral medication called metformin (brand name is Glucophage). Metformin has traditionally been used as an oral drug to help control diabetes. Then, some smart doctor figured out that polycystic ovarian syndrome treatment with metformin can be very effective. If Glucophage alone does not result in ovulation and pregnancy, we often use: If the combination therapy is not effective, we can try: Metformin Use with IVF Treatment We also use Glucophage in women going through in vitro fertilization for PCOS, and for those with very high antral follicle counts - if their ovaries are "polycystic" by ultrasound. We find that some women with polycystic ovaries respond with a "smoother" response to the injectable FSH medication if they have been taking Glucophage. Risks and Side Effects of Metformin / Glucophage In about 25% of women Glucophage causes side effects which may include abdominal discomfort, cramping, diarrhea and nausea. The side effects may be severe enough to make the woman stop the Glucophage medication. We are not aware of any serious complications resulting from Glucophage treatment. Another oral medication used for diabetes called Troglitazone has been associated with liver failure and death in rare cases. This has been publicized on television shows, in newspapers, et Continue reading >>

Can Metformin Help With Weight Loss?

Can Metformin Help With Weight Loss?

Metformin is a drug prescribed to manage blood sugar levels in people with type 2 diabetes. You may have heard that metformin can also help you lose weight. But is it true? The answer is a resounding maybe. Here’s what you should know about what metformin can do for weight loss, as well as why your doctor may prescribe it for you. According to research, metformin can help some people lose weight. However, it’s not clear why metformin may cause weight loss. One theory is that it may prompt you to eat less by reducing your appetite. It may also change the way your body uses and stores fat. Although studies have shown that metformin may help with weight loss, the drug is not a quick-fix solution. According to one long-term study, the weight loss from metformin tends to occur gradually over one to two years. The amount of weight lost also varies from person to person. In the study, the average amount of weight lost after two or more years was four to seven pounds. Taking the drug without following other healthy habits may not lead to weight loss. Individuals who follow a healthy diet and exercise while taking metformin tend to lose the most weight. This may be because metformin is thought to boost how many calories you burn during exercise. If you don’t exercise, you likely won’t have this benefit. In addition, any weight loss you have may only last as long as you take the medication. That means if you stop taking metformin, there’s a good chance you will return to your original weight. And even while you’re still taking the drug, you may slowly gain back any weight you’ve lost. In other words, metformin may not be the magic diet pill some people have been waiting for. It has been shown to reduce weight in some, but not others. One of the benefits of metformin Continue reading >>

Metformin And Weight Loss In Obese Women With Polycystic Ovary Syndrome: Comparison Of Doses

Metformin And Weight Loss In Obese Women With Polycystic Ovary Syndrome: Comparison Of Doses

Context: Metformin treatment of women with polycystic ovary syndrome (PCOS) is widespread, as determined by studies with diverse patient populations. No comparative examination of weight changes or metabolite responses to different doses has been reported. Objective: The aim of this study was to determine whether different doses of metformin (1500 or 2550 mg/ d) would have different effects on body weight, circulating hormones, markers of inflammation, and lipid profiles. Design: The study included prospective cohorts randomized to two doses of metformin. Setting: The study was performed at a university teaching hospital with patients from gynecology/endocrinology clinics. Patients: The patients studied were obese (body mass index, 30 to <37 kg/m2; n = 42) and morbidly obese (body mass index, ≥37 kg/m2; n = 41) women with PCOS. Intervention: Patients were randomized to two doses of metformin, and parameters were assessed after 4 and 8 months. Main Outcome Measures: The main outcome measures were changes in body mass, circulating hormones, markers of inflammation, and lipid profiles. Results: Intention to treat analyses showed significant weight loss in both dose groups. Only the obese subgroup showed a dose relationship (1.5 and 3.6 kg in 1500- and 2550-mg groups, respectively; P = 0.04). The morbidly obese group showed similar reductions (3.9 and 3.8 kg) in both groups. Suppression of androstenedione was significant with both metformin doses, but there was no clear dose relationship. Generally, beneficial changes in lipid profiles were not related to dose. Conclusion: Weight loss is a feature of protracted metformin therapy in obese women with PCOS, with greater weight reduction potentially achievable with higher doses. Additional studies are required to determine wh Continue reading >>

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