Influences On Prescribing Behavior In Diabetes
Influences on Prescribing Behavior in Diabetes A recent study,[ 1 ] conducted by three pharmacists and a nurse, explores why only 65% of patients with newly diagnosed type 2 diabetes (T2DM) and only 25% of people with ongoing T2DM are prescribed metformin. Although metformin is recommended as a first-line treatment for T2DM, it is still underused by clinicians who manage patients with T2DM. Using two focus groups with a total of 14 participants, including physicians, nurse practitioners, physician assistants, and pharmacists, the study explored situations in which clinicians were hesitant to prescribe or may have discontinued metformin use. These situations included renal insufficiency, heart failure, hepatic dysfunction, alcoholism, current or historical lactic acidosis, and manufacturer-listed contraindications. Despite a lack of scientific evidence supporting the precautions or contraindications to metformin use listed by the manufacturer, many clinicians were not comfortable prescribing metformin in the presence of a precautionary condition or contraindication. After a brief educational presentation about the evidence on the risks associated with metformin, the investigators reassessed the clinicians' level of comfort in prescribing metformin to patients with T2DM and such coexisting conditions as renal insufficiency, heart failure, and contraindications. They found that the participants were more likely to use metformin in these patients. The researchers concluded that the beliefs held by many clinicians about the risks associated with metformin use in T2DM are not consistent with the available evidence. They suggest that metformin use in patients with T2DM can be increased through clinician education to improve their level of comfort in using metformin in patient Continue reading >>
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
- Diabetes doctors: Which specialists treat diabetes?
The Facts About Diabetes Your Doctor Won’t Tell You
Type 2 diabetes has become a health-destroying epidemic afflicting millions of Americans. If you want to avoid this scourge or deal with it more effectively, there are facts about this disease you need to know that even your doctor may not understand. Almost 30 million Americans suffer diabetes. Another 86 million have what’s called pre-diabetes: This occurs when your blood sugar has begun to climb to unhealthy levels but it hasn’t yet reached the destructive point at which diabetes ensues. Drug problem One of the main drugs used to treat type 2 diabetes is a pharmaceutical called metformin. And while this drug may be an important treatment for controlling the blood sugar of many people, researchers are starting to raise concerns about its effect on the thyroid gland. A Canadian study coordinated between the Lady Davis Institute, Jewish General Hospital and the Department of Oncology, McGill University in Montréal demonstrates that metformin can boost the chances that someone with an under-active thyroid will have a reduced level of thyroid-stimulating hormone (TSH). That reduced level of TSH may, in turn, raise the risk of heart disease and bone fractures. The researchers found that in people who were already being treated for low thyroid, taking metformin expanded the risk of running low of TSH by 55 percent. In people who had normal thyroid, metformin did not seem to produce this effect. “The results of this longitudinal study confirmed that the use of metformin was associated with an increased risk of low TSH levels in patients with treated hypothyroidism,” says researcher Laurent Azoulay. “Given the relatively high incidence of low TSH levels in patients taking metformin, it is imperative that future studies assess the clinical consequences of this effec Continue reading >>
Why Is Metformin Considered The Drug Of Choice For Type 2 Diabetes?
Gunda Siska, PharmD, has worked in various fields within the pharmaceutical industry as a licensed pharmacist for more than 20 years. She is currently a staff hospital pharmacist assisting nurses and doctors with drug prescribing, administration, and dispensing, as well as independently monitoring and dosing highly toxic and dangerous drugs. For 2 years, she was concurrently a consultant pharmacist for skilled nursing facilities and nursing homes. Dr. Siska is a member of the New Mexico Society of Health-System Pharmacists and the American Academy of Anti-Aging Medicine. Follow her on Twitter @GundaSiska Metformin is a medication that I believe is underappreciated by the general public. Many people ttell me that their doctor prescribed this drug for them, but they took themselves off of it, but if they knew what I know about metformin, they would have stayed on the medication. This is what I know: metformin extends life. It’s been proven in animal studies1 and in humans. A prospective observational study of nearly 20,000 people with type 2 diabetes mellitus (T2DM) and arteriosclerosis found that metformin use was associated with 24% lower all-cause mortality compared to patients who were not taking metformin.2 It is also the number one go-to medication for type 2 diabetes for several years, despite all the new designer medications coming on the market trying to replace it. How does metformin save lives? Mainly through cardioprotection. Metformin reduces cardiovascular risk in humans.3 Most people with T2DM will most likely die from a cardiovascular event, especially if they are not on metformin.4,5,6 Metformin has so many positive effects on the body, no one really knows for sure all the ways it preserves life. It produces modest weight loss in the near term5 and blun Continue reading >>
Metastudy Confirms Metformin Appropriate Treatment For Prediabetes
A study that reviewed several previous studies about the impact of using metformin on the progression of prediabetes to diabetes confirms that yes, people with prediabtes who take metformin end up with better blood sugars after 3 years than those who don't and are therefore less likely to be diagnosed with full-blown diabetes. This isn't original research, it's just a look at the major studies that have examined the impact of metformin on prediabetes. But because I hear from so many people with prediabetes whose doctors won't give them any help at all, I though it worth a look. Treating prediabetes with metformin: Systematic review and meta-analysis Muriel Lilly, Can Fam Physician Vol. 55, No. 4, April 2009, pp.363 - 369 The key issue to remember here is that the concept that "prediabetes" progresses to "diabetes" which treats the two conditions as if they were separate diseases is flawed. In fact, the medical definition of "diabetes" is completely arbitrary. A committee years ago chose some blood sugar test results and defined them as "diabetes." They could have--and many argue should have--chosen different test result numbers. But they chose the ones they did mainly, their own documentation showed, to diagnose people with diabetes as late as possible, because of the severe penalties the American medical system imposes on people who have pre-existing conditions. You can read about how the diagnostic standards for diabetes were set HERE. "Prediabetes" was also defined arbitrarily at the same time as "diabetes" was defined and as has been the case with diabetes, the definition has changed over the years. But what you, the person with abnormal blood sugar, need to understand is that there's no sudden change in your health that happens when you get an official diabetes dia Continue reading >>
Why Would A Doctor Prescribe Metformin To A Hypoglycemic Patient?
Question Originally asked by Community Member slywlf Why Would A Doctor Prescribe Metformin To A Hypoglycemic Patient? A dear friend was diagnosed years ago with hypoglycemia, caused by her thyroid, while other members of her family have hyperglycemia (diabetes), and are almost all on an insulin regimen. What I do not understand is why her doctor has her on Metformin!? Isn’t that counterproductive? Her current thyroid medicine seems to be making her gain weight - it is not her diet, which is healthy and portion controlled. Since she is on Medicaid it is often hard to get meds switched. Also, she is reluctant to risk alienating one of the few local doctors who are still willing to take Medicaid, so she is worried about questioning her doctor about this. What possible purpose is served by giving a glucophage to a person with chronic low blood sugar? I am baffled and concerned! My friend has many health issues besides the thyroid and hypoglycemia, including a degenerative disk problem, a damaged ankle from a fall a few years ago, increasing eye problems since that fall, and social anxiety disorder. She also has a very low IQ, which she is very much aware of, and which makes her reluctant to confront people she perceives as smarter than herself, particularly doctors. She is 60 years old, and I worry that this doctor is not treating her condition correctly, but my own knowledge of hypoglycemia is limited to what I have found on the web - much of which seems related to overdoses of insulin in diabetics, which is not the issue here. Answer Doesn’t make any sense to me. First of all, thyroid conditions don’t cause hypoglycemia. Second, giving metformin would be worthwhile to treat either diabetes or prediabetes, especially in a family setting of diabetes, but if she’s h Continue reading >>
Why Good Doctors 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 (LAc, DOM(NM), 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. 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 medication with the approval of your doctor. Never underestimate the influence you have on those around you. Your wo Continue reading >>
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 >>
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 (LAc, DOM(NM), MS Nutrition), an Austin-based doctor who used to suffer type II diabetes herself, made a recent announcement that is sending shockwaves through the medical community. After nearly dying from diabetes complications during a bike ride, Dr. Merritt began extensive research, intent on reversing her type II diabetes before succumbing to diabetic amputation, blindness, organ failure, or any of the other side effects so commonly experienced by diabetics. 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 and self-experimentation, Dr. Merritt developed a simple diet and exercise regimen that had a profound success rate in treating and even reversing type II diabetes. Despite reversing her own diabetes, and helping many of her patients do the same, 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. Continue reading >>
Ignore The Clickbait: Metformin Still Prescribed For Diabetics
Dear Dr. Roach • I have read online and in our local newspaper that doctors are no longer recommending metformin as a treatment for Type 2 diabetes. Can you please explain why metformin is no longer being prescribed? — P.K. Answer • I, too, have seen online ads saying that doctors no longer prescribe metformin, and if you click through enough times, you find that “one weird food” cures diabetes, and that a special diet totally eliminates the need for medication for all diabetics. This is referred to as “clickbait,” and I encourage you not to pay attention to it. Metformin remains an important medication for many people with Type 2 diabetes, especially if they are overweight. For those people with diabetes who need medication despite an appropriate diet and regular exercise, metformin has been shown to be more beneficial, in terms of preventing diabetic complications and death, than most of the other medication options. It isn’t right for everyone, and people with poor kidney function may not be able to safely take it. Only your doctor, nurse practitioner or physician assistant knows what is best for you. Dear Dr. Roach • I started researching information about early dementia and also Alzheimer’s disease. I have perused numerous articles about cholinesterase inhibitors increasing acetylcholine levels that benefit the brain. Some medications are anticholinergic and might increase your risk of developing Alzheimer’s disease. Many of these medications are everyday, over-the-counter drugs. Shouldn’t the public be made aware of these drugs and their possible effect on our brain? — P.C. Answer • One type of treatment for Alzheimer’s disease is a class of drugs called cholinesterase inhibitors. These include donepezil (Aricept) and others. Pharmaco Continue reading >>
Common Drug Has The Potential To Slow Aging, Boost Cancer Recovery
Some exciting research from the University of Montreal has found that the drug metformin, commonly prescribed for diabetes and polycystic ovary syndrome (PCOS), has the potential to slow aging and fight cancer. The study, published in Aging Cell, found that metformin reduces the body's production of inflammatory cytokines, which accelerate aging. Metformin is the generic name for an oral drug that was approved by the FDA in 1994 to lower blood sugar. Brand names include Glucophage and Glucophage XR (Bristol-Myers Squibb), Fortamet (Shionogi), Glumetza and Glumetza XR (Santarus), and Riomet (Ranbaxy). Metformin was later found to stimulate ovulation, regulate periods, and increase fertility in women with PCOS and is now commonly prescribed for women whose PCOS hasn't responded to hormonal treatment alone. Found: New Potential to Slow Aging, and Slow Tumor Growth Cytokines have an important function in the body, activating the immune system to fight infection. But because they work by an inflammatory process, when they're overproduced they put the body into a state of chronic inflammation, which causes cells to age faster. Interestingly, the University of Montreal study found that the molecular pathways used to cause these anti-aging and anti-cancer benefits are not the same pathways used when metformin treats diabetes or PCOS. Previous research has suggested the anti-aging and anti-cancer possibilities of metformin, but had not gone as far as to document the mechanism that makes this happen. (Here's my previous reporting on how the inflammatory response ups the risk of stroke and other potentially fatal conditions.) Should You Ask Your Doctor About Metformin? If you're interested in Metformin's anti-aging potential in general, I doubt right now you'll get far asking your Continue reading >>
Dr Won't Prescribe Metformin
Friend T2 since Jan 26,2009, looking for guidance I don't understand this doctor. Wasn't there some study recently that showed how metformin could help prevent diabetes in pre-diabetic people? So it seems very irresponsible for this doctor to deny you this treatment until you are "actually" diabetic per her opinion. Seems to me if your Doctor says you are "pre" Diabetic what is he/she waiting for.If you are getting readings over 140 on a consistent basis it is time to start attacking the problem.I see no reason why you should not be on 1000 mg a day (mabey 500 to start)and see what your reaction is to it.My sugar levels were never absurdly high 200 was a rare occassion for me and 140-80 norms.Metformin has changed my life so much and for the better is unbelievable.My Doctor actually just asked me if I wanted to lessen the dosage from 1500 mg a day.I walked out with a new script for 1650 a day I think he gets my point.If you monitor daily why wouldn't you want to give it a shot.What are your highest numbers? Type 2 taking Metformin XR also actos which I plan to stop.Last A1C was 6.7 2-25-09 A1c 6.1.... 8-12-09 5.9...2-2010 5.7 8-12-09 Will now take 2 1000 mg Met per day Someone, somewhere - I can't remember which side of the Atlantic this person was - said that the HbA1c was a good guide to whether a person is diabetic or not, and that levels below 7 indicated that a person wasn't diabetic. Err no. it just means you've got the thing under control. I am a diagnosed diabetic with an HbA1c of below 7. I don't know which planet this person is on, but it's not this one, but I think they were a medical professional (there's an advisory on the use of that word!) Voltaire said:- "It is better to remain silent and be thought a fool than open one's mouth and remove all doubt!" Continue reading >>
Variations In Metformin Prescribing For Type 2 Diabetes
Abstract Background: Reasons for suboptimal metformin prescribing are unclear, but may be due to perceived risk of lactic acidosis. The purpose of this study is to describe provider attitudes regarding metformin prescribing in various patient situations. Methods: An anonymous, electronic survey was distributed electronically to 76 health care providers across the nation. The 14-item survey contained demographic questions and questions related to prescribing of metformin for T2DM in various patient situations, including suboptimal glycemic control, alcohol use, history of lactic acidosis, and varying degrees of severity for certain health conditions, including renal and hepatic dysfunction, chronic obstructive pulmonary disease, and heart failure. Results: There were a total of 100 respondents. For suboptimal glycemic control, most providers (75%) would increase metformin from 1500 to 2000 mg daily; however, 25% would add an alternate agent, such as a sulfonylurea (18%) or dipeptidyl peptidase-4 inhibitor (7%). Although 51% of providers would stop metformin based on serum creatinine thresholds, the remainder would rely on glomerular filtration rate thresholds of <60 mL/min (15%), <30 mL/min (33%), or <15 mL/min (1%) to determine when to stop metformin. For heart failure, 45% of providers would continue metformin as currently prescribed regardless of severity. Most providers would adjust metformin for varying severity of hepatic dysfunction (74%) and alcohol abuse (40%). Conclusions: Despite evidence supporting the cardiovascular benefits of metformin, provider attitudes toward prescribing metformin are suboptimal in certain patient situations and vary greatly by provider. Methods A 14-item survey was developed and modified based on feedback from a small focus group of pr Continue reading >>
- Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study
- Is It Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes
- New type of diabetes discovered - Could YOU be showing symptoms of type 1.5 NOT type 2?
Why Isn’t Metformin Prescribed More?
Since its debut in the United States in 1995, metformin has become the most popular oral drug for Type 2 diabetes in the country — and the rest of the world. Current guidelines by the American Diabetes Association state that unless there are special risks in a particular person, metformin should be the first drug prescribed to people with Type 2 diabetes. Yet perhaps due in part to its popularity, metformin isn’t free of controversy. As we’ve discussed previously here at Diabetes Flashpoints, there are concerns about prescribing metformin in people with kidney disease, and some doctors even question whether metformin deserves its status as the universally recommended first-line drug for Type 2 diabetes. In addition, there’s debate about whether metformin should be taken by more people with prediabetes. A recent study sought to explore the reasons why metformin isn’t prescribed as widely as clinical guidelines suggest it should be. Published last month in the journal Therapeutic Advances in Chronic Disease, the study notes that only roughly 65% of people with newly diagnosed Type 2 diabetes are prescribed metformin — and that over time, this number drops to just 25% of people with the condition. As noted in a Pharmacy Times article on the study, researchers from the University of Colorado put together focus groups of relevant people — doctors, pharmacists, and other medical personnel — to ask about their perceptions regarding metformin. Based on these focus groups, the researchers found that three main factors affected how doctors prescribed metformin: concerns about when to start the drug, concerns about the drug’s known risks, and whether procedures were in place to notice and deal with any adverse reactions caused by the drug. Based on the focus grou Continue reading >>
Metformin: Is It Really The Best Treatment For Pcos?
If you suffer from diabetes, or have ever had a close friend or family member who was a diabetic, you might be familiar with the name of a drug called Metformin. It is not the only medication prescribed for diabetes, but it is one of the more common ones, and in many cases it yields results. According to the National Library of Medicine, Metformin is a drug often used to treat Type 2 diabetes. And the reason for this is clear: This medication has shown results in controlling the amount of glucose in your blood, which can be effective in managing or stabilizing a diabetic condition. The problem is that Metformin is not only prescribed for diabetes. Because of its effect on blood glucose, many doctors also give it to women suffering from PCOS (Polycystic Ovarian Syndrome). This condition is closely linked to Insulin Resistance, the inability of the body to properly use glucose form the blood. But this medication was not necessarily made to be given to those who suffer with PCOS (Polycystic Ovarian Syndrome) and the side effects can far outweigh the potential efficacy. Metformin: Hazardous to Your Health? While the Mayo Clinic reports that Metformin is often administered to PCOS (Polycystic Ovarian Syndrome) patients—despite the fact that it is not approved for this use—the drug comes with a variety of potential side effects that any prospective user should know about in advance. Some of them are relatively innocuous, such as gas or stomach pain, but there is also a reported risk of liver damage and moderate to severe infections. These side effects might be easier to overlook if the drug were actually intended for use in PCOS (Polycystic Ovarian Patients), but its label gives no indication that this is its intended use. But not to worry: There is a better way to combat Continue reading >>
- Improve your health naturally | Diabetes Treatment With Mango Leaves Is Really An Effective Option?
- Weight Watchers Jumps Eight Spots To #3 Best Diabetes Diet And Retains Top Spot As Best Fast Weight Loss Diet In 2018 Best Diets Report
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
Experts Recommend Two-pronged Approach To Treating Prediabetes
According to the most recent data compiled by the CDC, 57 million U.S. adults have prediabetes, a figure that has reached pandemic levels. “In an ideal world, you want to diagnose high-risk people early in order to prevent progression to full-blown diabetes and its associated complications,” Glenn Matfin, MD, clinical associate professor at New York University and senior staff physician at the Joslin Diabetes Center, told Endocrine Today. Whether prediabetes progresses to diabetes depends on a number of variable factors, including lifestyle changes, genetics and treatment practices, which have some physicians supporting the use of medication and others vehemently against it. “We draw lines in order to differentiate between normal glucose tolerance, prediabetes and diabetes, but it is an interlinked, continuous chain,” Matfin said. “The clock is ticking, and the health risks rise significantly as prediabetes goes untreated.” To examine the current state of prediabetes treatment, Endocrine Today spoke with a number of experts to best understand how lifestyle and pharmacological approaches should be utilized to reverse glucose functions to normal levels. The issue is also examined from a financial aspect, as the ability to keep patients with prediabetes from turning into patients with diabetes translates into hundreds of millions of dollars saved in health care costs. Ralph DeFronzo, MD, and diabetes experts discuss preferred therapeutic approaches for people with prediabetes. Perhaps due to its subtle set of symptoms, the identification and diagnosis of patients with prediabetes has proved to be a challenge. Research has shown that although 30% of the U.S. population had prediabetes in 2005 to 2006, only 7.3% were aware that they had it. A consensus from diabe Continue reading >>