All About Diabetes» metformin

Metformin Top Oral Antidiabetes Medicines

admin — Thu, 17 Jun 2010 05:36:00 +0000

An oral medication for type 2 diabetes that has been in use for more than a decade was found to have distinct advantages compared to nine other, much-newer medications used to control the chronic disease, according to researchers from the Johns Hopkins Institute.

Results of the study, published online in the Annals of Internal Medicine journal, showed that the drug metformin, first approved by the United States Food and Drug Administration in 1995, did not only control blood sugar levels, but also lowered bad cholesterol levels in the blood, with less weight gain. Researchers agree that these health benefits may protect type 2 diabetics against heart diseases and other complications brought about by the disease.

According to Shari Bolen, MD, lead author of the study and an instructor at The Johns Hopkins University School of Medicine, newer drugs doesn’t necessarily mean they’re better. “Issues like blood sugar levels, weight gain and cost could be significant factors to many patients struggling to stay in good health,” says Bolen.

Bolen and her team reviewed scientific evidence from 216 previous studies and compared each drug for its clinical effectiveness, risks and costs. The study, which is believed to be the largest drug comparison of its kind, showed that all of the commonly used oral medications work in much the same way in terms of lowering and controlling blood sugar levels, and all were equally safe.

‘When you are dealing with an epidemic like diabetes, it is important for people to weigh their treatment options with their physician and to make informed decisions about which medication best suits their needs,” said Bolen. Researchers say further studies are needed to compare the long-term effectiveness of one oral medication to another, as well as the drugs’ effects on quality of life and life expectancy. More researches are likewise needed to compare the findings of the said study with results for injectable for diabetes, including insulin.

Metformin Helps Obese Teenage Girls

admin — Sat, 29 May 2010 05:55:02 +0000

A lifestyle modification program along with metformin, a drug commonly used by type 2 diabetics to lower blood sugar level, may help teenage girls lose weight if they make changes in their diet as well, according to a study.

To test its effectivity, researchers examined the effect of adding metformin versus placebo to a personal diet and exercise goal-setting program for 85 obese adolescents with insulin resistance, 71 percent of whom were female. Researchers report in the Journal of Pediatrics that goal-setting alone did not lead to significant weight loss. However, researchers observed a significant decrease in body weight in girls receiving metformin, but not in those receiving placebo. A decrease in body mass index of more than five percent were seen in 60 percent of the participants who took metformin and at the same time cut back on their diet.

“Current options for weight loss medications are fairly expensive and not typically covered by insurance plans,” noted Dr. Kathryn Love-Osborne of Denver Health and Hospitals in Colorado in her comments to Reuters Health. “As such, medications are not readily accessible to low-income patients who are at higher risk for obesity-related complications.”

As such, researchers concluded that the availability of safe and inexpensive medications that might provide additional benefits for patients who are motivated to make modest lifestyle changes would be a welcome option for primary care providers who are working with obese teens.

Better Early Than Sorry

admin — Sat, 14 Mar 2009 11:10:02 +0000

A couple in their early thirties gushed at the sight of their lovely first-born, tickled pink with that perfectly delicate smile. The mother, who had gestational diabetes (pregnancy-related diabetes), almost wept while recalling her difficult pregnancy. But it was all over, she thought. Although the baby was bigger than usual, he had a complete set of fingers and functioning vital organs.

The same baby grew to become an overweight kid. During his pubescent years, the doctors found he had type 2 diabetes. These days, it seems no one is too young to develop diabetes as long as one possesses the risk factors. An ounce of prevention is better than a pound of cure, so goes the old adage. Yet people still subconsciously, or even consciously, opt for the latter choice. “Real prevention must start at birth. You can never be early in preventing but you can be too late,” Philippine Diabetes Association (PDA) vice-president Dr. Editha Arceo-Dalisay said.

Preventable Disease
According to the 2006 data of the International Diabetes Foundation, diabetes afflicts about 246 million people worldwide. Only about 50 percent are aware of their condition. A significant chunk live without an inkling that they have diabetes or that they are likely candidates to have diabetes.

The World Health Organization predicted diabetes prevalence would hike from roughly 2.8 million in 2000 to 366 million in 2030. Considering the rate of newly-diagnosed diabetics every year, the foretold figure is not far-fetched. However, many would be surprised to know that this fatal disease, which directly causes 3.8 million deaths annually, is preventable.

The nature of the disease itself shows it can be prevented. According to the American Diabetes Association, too much fat around the waist accelerates a person’s chance of developing insulin resistance, a known precursor to diabetes. The pancreas of a person with insulin resistance secretes more insulin than what is essential. But gradually, insulin production is impaired. Insulin secretion fails to meet the needs of the body after taking meals.

“[Type 2] diabetes occurs when body produces insulin that cannot be taken up by the body, muscles, and fat. This condition is called insulin resistance and one of the factors resulting to this is obesity. One has to avoid being fat through adapting healthy lifestyle,” explained Dr. Honolina Gomez of the Philippine Center for Diabetes Education Foundation (PCDEF).

Published studies have in fact shown it is possible to delay and even prevent diabetes through modifications in lifestyle. The Diabetes Prevention Program (DPP) aimed to find out whether diet and exercise or a diabetes drug could prevent the onset of type 2 diabetes in people with impaired glucose tolerance (IGT). The subjects were grouped into three. One group underwent a diet and exercise program while the other group received metformin. The third group was given placebo (sugar pill).

Results of the three-year major trial showed lifestyle modification and metformin reduced onset of diabetes by 58 percent and 31 percent, respectively. The study suggests weight loss obtained from diet and exercise improves the capacity of muscle cells to utilize insulin and enables better handling of glucose.Similar results were also found in the Finnish Diabetes Prevention Study. The 522 randomly assigned “middle-aged overweight subjects with IGT” were divided into intervention and control groups.Changes in lifestyle were found to be more effective in preventing the disease.

“All of these studies would show that if you do lifestyle modification, including dietary and intense physical activity, you can actually delay the progression of diabetes. The use of medications like metformin also show that these can help delay the course of diabetes,” according to Dr. Josephine Carlos-Raboca, president of the Philippine Society of Endocrinology and Metabolism (PSEM). She said subjects included in the study had pre-diabetes, the stage wherein blood sugar is not exactly normal yet not high enough to be considered diabetic.

All-out Prevention
The preventable kind of diabetes, type 2, is also a hereditary one. The scenario given earlier in the article hints at when prevention ought to start. Children of parents with diabetes, even gestational diabetes, are automatically at risk of having the disease. Obesity coupled with lack of physical activity is likewise a risk factor. According to Dr. Dalisay, highrisk individuals can prevent diabetes through either pharmacologic or nonpharmacologic methods.

Non-pharmacologic or lifestyle intervention
Dr. Dalisay said this just translates to promoting healthy lifestyle. “I ask the patients to look into their food, the way they eat, basically reducing the calories and fats and increasing fiber in their diet. I also encourage them to view exercise as typical activity.” In the DPP study, those under this group were given intensive training in modifying diet, exercise, and behavior. Specifically, the study aimed to lose seven percent of the patients’ body weight by means of eating less fat and calories, and doing exercise for 150 minutes a week.

“With lifestyle intervention, the effect is still there on the patients even after the study,” she added. In communicating with her patients, Dr. Gomez makes it a point to be specific. She demonstrates how much fruit can be eaten (e.g., a handful orthat of the size of her fist) and how one can exercise in installments for a day (“I tell them to clean their cars for ten minutes”). Dr. Dalisay considers changes in lifestyle the cheaper and more effective way of preventing diabetes. “In a country like ours where financial aspect is a very important consideration in treatment, the concept of lifestyle intervention is very enticing. One doesn’t even have to go to a gym or enroll in exercise programs.” However, the cheaper way is also the more difficult to do for, patients, she added. Indeed, it’s easy to instruct patients to avoid feasting on fatty food and to eat green leafy vegetables instead; however, compliance is never guaranteed. “Food is comfort for us, for Filipinos,” Dr. Dalisay continued. “As much as possible, I avoid saying “bawal ito, bawal yan”.
I try not to present my advice in such a negative way. Motivation is the hardest thing. Some patients would ask for a medication because it’s more convenient, just one pop a day.” When it comes to exercise, Dr. Dalisay encourages patients to look for a physical activity or hobby that would double as a form of exercise. She cites badminton and dancing as good examples of activities that are popular, fun to do, and keep patients fit.

Weight loss is the fruit of proper diet and exercise. According to the American Diabetes Association, “losing just five percent of body weight can improve blood sugar control and can reduce the risk of cardiovascular diseases.”

Pharmacologic
Another option for prevention is through the use of drugs such as metformin, acarbose, rosiglitazone and pioglitazone. Last year, results of a major study showed diabetes drugs are also effective in altering the course of diabetes. In the Diabetes Reduction Assessment with ramipril and rosiglitazone Medication (DREAM), it was found that rosiglitazone can significantly reduce risk of diabetes by 62 percent if coupled with proper diet and exercise. Only 10.6 percent of subjects who took rosiglitazone developed diabetes while 25 percent of subjects in the control group did.

Medical experts are quick to stress that drugs are only secondary to diet and exercise. Dr. Gomez noticed that those patients whom she asked to take medications did lose weight, but only for a certain period of time. “They [those prescribed with diabetes drug tend to gain weight again unless you change their behavior and gear them towards healthy lifestyle,” she said. “There are some individuals who really have a hard time doing exercise so you have to supplement them with a drug. They go hand in hand,” she added.

On the same note, Dr. Dalisay explained drug management or pharmacologic treatment is the next best thing for those who cannot comply with lifestyle modification. “There are a lot of cheap metformin preparations to be taken everyday that can delay diabetes for about. 15 years. The leeway period is not that bad,” she said.

Lay Education
Diabetes organizations play a significant role in spreading the good news: diabetes can be prevented. The PCDEF leads the yearly “Diabetes Awareness Week” in July and promotes prevention of diabetes and its complications through healthy lifestyle and mass screening programs. The kickoff activities are held simultaneously in various shopping malls.

The PSEM holds regular lay fora where they teach lifestyle modification to lay people. The society usually coordinates with different related organizations on this. “We don’t just talk about diabetes. We also show them how they can prevent obesity by increasing physical activity,” Dr. Raboca said. Truly committed to diabetes awareness and prevention, PDA is likewise active in educating the patients and their relatives through lay fora and annual convention.

“Education is a powerful tool for diabetes prevention. They won’t have motivation to adapt a healthy lifestyle if they don’t know what diabetes is all about and how they can prevent it,” according to Dr. Dalisay. Dr. Gomez, who is also a member of the American Association of Clinical Endocrinologists-Philippine Chapter, participates in the group’s activities for the lay. “We tell people that even if they don’t have family history of diabetes, they can still develop it if they lead a sedentary lifestyle and have weight problems,” she said. Dr. Gomez also has her hands full in manning the St. Thomas Diabetes Center at the University of Santo Tomas Hospital. Last March, she started a series of free lectures on diabetes. Before the fora, they gave patients pre-tests. By July, the last month of the lecture series, they would get the HbAlc of the patients to see how the lectures helped in keeping their blood sugar in check.

An ounce of prevention is better than a pound of cure, so goes the old adage. This is often heard but often taken for granted. Studies have shown us diabetes prevention is possible. Medical experts say it pays to invest in preventing diabetes as early as possible. As with the cliche, “the early bird catches the worm,” one who prevents diabetes early gets a worm: a lifetime free of diabetes.

A Pill to Prevent Diabetes?

admin — Sun, 08 Mar 2009 07:39:57 +0000

What if your entire life could be compressed into a twelve-hour clock ; and you knew you would develop diabetes at the eleventh hour, would a you turn the hands of time before it o struck eleven? Wishful thinking? Perhaps. But in a way, it IS possible to reset the 3 clock of diabetes.

Lifestyle first
Robust proof that lifestyle intervention can reduce the risk of developing diabetes does exist. Regular moderately intense physical activity (e.g., brisk walking -30 minutes daily), weight reduction (at least 7 percent) for the overweight and a healthy diet (low in saturated fat, high in fiber) have significantly lowered the incidence of diabetes by about 58 percent. Lifestyle change, however, is difficult to sustain. Is there a magic pill that can make diabetes go away? Now, that is wishful thinking. Evidence seems promising though, and in fact, some pills have been shown to cut diabetes risk considerably.

Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are abnormalities in the body’s ability to handle blood sugar usually lumped under the term prediabetes. Prediabetes is a condition wherein blood sugar levels
are higher than normal but not high enough to be labeled diabetic. In 2003, about 314 million adults worldwide had IGT. This figure is expected to skyrocket to 472 million by 2025 – way beyond the projected number for type 2 diabetes (380 million). The highest number of people with IGT live in Southeast Asia where the IGT prevalence is more than double that of diabetes.

Up to half of individuals with IGT will develop type 2 diabetes within 10 years. These people are also at higher risk for heart disease. The risk further rises with the onset of diabetes. Therefore, early aggressive steps to reduce the chances of at-risk individuals from developing frank diabetes are mandatory.

The International Diabetes Federation (IDF), American Diabetes Association (ADA), and the American Association of Clinical Endocrinologists (AACE) have all recently published guidelines for the prevention of type 2 diabetes. These organizations agree that lifestyle modification should be tried first. However, if diet and exercise interventions are not sufficient, then drug therapy may be considered in conjunction with them.

Drugs second
What medications have been shown to cut diabetes risk?

Metformin
In the Diabetes Prevention Program (DPP), lifestyle change slashed the risk of diabetes in people with IFG and IGT by 58% while metformin did so by 31%. In the Indian Diabetes Prevention Program (IDPP) both lifestyle change and metformin notably reduced the incidence of diabetes in Asian Indians with IGT, but no added benefit was seen with combining them. Relative risk reduction was 28.5% with lifestyle intervention, 26.4% with metformin and 28.2% with both lifestyle intervention and metformin combined.

The ADA recommends no other drug for diabetes prevention besides metformin and only under certain conditions. It recommends considering metformin for those with IFG and IGT and any of the following to prevent diabetes: age less than 60, body mass index (BMI) 35 kg/m and above, firstdegree relatives with diabetes, high triglycerides, low HDL or good cholesterol level, high blood pressure or HbAlc level over 6%. The IDF recommends metformin at lower cutoffs for BMI (above 30 or 27 kg/m’ depending on ethnicity).

Metformin is best avoided in patients with advanced kidney, liver, lung and heart disease and other conditions that predispose to lactic acidosis (buildup of lactic acid in the blood).

Acarbose
The STOP-NIDDM (Study to Prevent Non-Insulin-Dependent Diabetes Mellitus) trial found acarbose lowered diabetes risk by 25% and even certain heart-related problems by 49%. However, the study was limited by the drop-out of 31 % of the subjects largely due to side effects such as stomach upset, bloating and flatulence. Nevertheless the OF supports using acarbose in those who can tolerate its side-effects “to reduce diabetes and, potentially, cardiovascular risk”.

Glitazones
Troglitazone was shown to cut diabetes risk by 55% in women with prior gestational diabetes (diabetes during pregnancy) in the TRIPOD (Troglitazone in the Prevention of Diabetes) study. However, this drug was withdrawn from the market due to links with liver toxicity. Women in this study were then switched to pioglitazone in the PIPOD (Pioglitazone in the Prevention of Diabetes) study which showed lower risks of diabetes with pioglitazone. The DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) trial also showed that rosiglitazone reduced the risk of diabetes in prediabetic subjects by 62% compared to placebo.

The benefits of using glitazones though need to be weighed against the risks of potential adverse effects such as weight gain, fluid retention, congestive heart failure and fractures.

Orlistat
The XENDOS (Xenical in the Prevention of Diabetes in Obese Subjects) showed that the antiobesity pill orlistat cut diabetes risk by 37% when added to lifestyle intervention in obese subjects with IGT. However the study is limited by the low completion rate in the orlistat arm (52%). Adverse effects of orlistat include diarrhea, belly pain, nausea and flatulence. Overall, whether or not one pops a pill to prevent diabetes needs to be discussed with a physician taking into consideration one’s health condition and the cost of the pill not just to the pocket but also to one’s body. Ultimately, no pill can replace the benefits of a healthy lifestyle; so, eat right and move more to chuck diabetes.

Metformin Gum Tablets

admin — Sat, 07 Feb 2009 06:48:17 +0000

Generex Biotechnology Corporation, makers of the Generex Metformin Gum product, recently revealed results of a small study which showed that the gum presentation of metformin is as effective as the tablet form in the treatment of type 2 diabetes mellitus. Designed as a companion product to the company’s oral insulin spray product (Oral-lyn), Generex Metformin Gum is an alternative presentation of metformin that can be chewed, thereby delivering the active component metformin into the human cavity by the mouth.

Metformin is a drug used to treat type 2 diabetes in adults and children, especially when insulin resistance and obesity is present. The drug works by increasing the sensitivity of liver, muscle, fat and other tissues to the effects of insulin. Unlike other glucose-lowering drugs, metformin does not cause hypoglycemia (low blood sugar) and weight gain. Metformin users even report weight loss associated with metformin, suggesting an anorectic mechanism of the drug. However, a large number of metformin users develop gastrointestinal effects, including vomiting and nausea with the use of the drug.

The Generex Metformin Gum therefore shows promise as an alternative method of delivering metformin with lesser side effects. Manufacturers of metformin gum hope that the gum presentation can significantly avoid the significant adverse gastrointestinal effects associated with the tablet presentation of metformin, and that it may help improve patient compliance to their medication.