Practical Practitioner

By: Pamela Egan, FNP-C CDE

Diabetes Treatment: Metformin reduces symptoms of diabetes, heart disease

Dear Pam,

My mother has had Type 2 Diabetes for six years. She takes a sulfonylurea (Glucotrol XL) and insulin. Her blood sugars still run high in the 300’s and her HAIC (average blood sugar for 4 months) is 15.6 percent.

It is apparent that the medications that your mother is taking are not working. How’s her diet, specifically starch intake? Is she able to exercise? With Type 2 Diabetes, 95 percent of individuals have insulin resistance.

This means that the pancreas is making insulin, but it cannot work properly in moving glucose into the cells. Your mother probably requires an insulin sensitizing medication such as Metformin and/or Actos or Avandia. There is new research showing that Metformin is the drug of choice for new Type 2 diabetics.

Metformin not sulfonylureas needs to be the first treatment after diet and physical activity for Type 2 Diabetes.

A new review of studies confirms that the drug metformin should be in the first line of defense against Type 2 Diabetes.

Using Metformin alone can improve control of blood glucose, while also reducing risk factors for heart disease such as excess body weight, cholesterol levels and hypertension, the review found.

The systematic evidence review included 29 trials comparing the benefits of metformin to placebo, dietary changes, other oral medications and insulin therapy. The studies comprised a total of 5,259 participants and had a minimum follow-up period of three months.

The review suggests the use of Metformin by itself as first-line therapy in the management of type 2 diabetes and the prevention of its vascular complications. In type 2 diabetes, due to insulin resistance, insulin produced by the pancreas is not able to get sugar from the blood into the body’s muscle and cells.

Metformin normalizes blood sugar by increasing uptake in the liver, muscle, fat, and other tissues. This study focused on the same health outcomes as the United Kingdom Prospective Diabetes Study, the largest and longest diabetes study undertaken to date including diabetes-related problems such as heart attack, stroke, kidney failure, nerve damage, amputation, blindness and death.

In overweight Type 2 Diabetics, intensive Metformin shows more benefit than other drugs or insulin therapy for reducing the risk for any complications related to Type 2 Diabetes, including death and stroke.

The review confirms that tight glucose control with Metformin alone is one of the main therapeutic options for patients with Type 2 Diabetes Mellitus who are overweight or obese. In addition, the adverse effects of metformin mainly on the digestive tract, are not life-threatening. Metformin first became available in Europe in 1979, but was not cleared for use in the United States until 1994 due to concerns about a potentially fatal complication called lactic acidosis. Diabetes takes a severe toll on blood vessels throughout the body, especially when combined with other cardiovascular risk factors. Two out of three people with diabetes die from heart disease and stroke, according to the American Diabetes Association.

This article was originally published August 15, 2005 in The St. Tammany News.

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