Metformin, should i or shouldnt i go for it?

[Mothman]

My doctor keeps asking me to go on metformin, ime so far controlling my T2 with diet alone and have been doing so for nearly 2 1/2 years. She says that new thinking is that all T2s should be on it after 6 months whether they control their diabetes with diet or not. Ime still not too happy to go on it if i can help it.

Andy

 

[lessci]

Personally, if your control and Hbac1 figures are good, why take a medication that you don't need. I wouldn't take an asprin justin case I got a headache! Ask the GP what research the recommendations are based on, read up and ask questions before you make an informed choice.

 

[hanadr]

I read a lot of research papers and haven't seen anything about putting all T2s onto Metformin. In fact the only thing I saw a while back was a suggestion for putting everyone onto insulin. I would say if your HbA1c is at a safe level [prefeably in the 30s, you should continue with your diet. If your Hba1c is above 45 or so, I'd go with the Metformin. the medication is pretty safe and has been used for quite a while.
I'd definitely ask to see the evidence your doctor refers to.
Hana

 

[PhilT]

Isn't the effect of Metformin limited to about 1.0 mmol/l reduction ? If so would that be enough.

 

[VinnyJames]

I read some research recently that was statistically significant to show that diet and exercise is twice as effective compared to metformin alone.

http://care.diabetesjournals.org/content/35/4/723

 

[2131tom]

I read some research recently that was statistically significant to show that diet and exercise is twice as effective compared to metformin alone.

http://care.diabetesjournals.org/content/35/4/723

Hi, Vinny.

I'm a bit confused about that - am I missing something? Not unusual if I am, but your link directs us to a cost-effectivness study which ends:

CONCLUSIONS: Over 10 years, from a payer perspective, lifestyle was cost-effective and metformin was marginally cost-saving compared with placebo. Investment in lifestyle and metformin interventions for diabetes prevention in high-risk adults provides good value for the money spent.

FWIW, my understanding is that, as well as its role in helping to control BG, there's some evidence that Metformin may have other beneficial effects for many T2s (e.g. in assisting weight loss), as well as having a good safety record since its discovery in the late 1950s.

 

[VinnyJames]

This link explains it better;

http://www.nejm.org/doi/full/10.1056/NEJMoa012512

Metformin and lifestyle intervention are both proven to work although I've seen a few people say metformin only gives a 1 mmol percentage reduction.

I'm seeing my GP tomorrow and going to ask him if I can come off metformin simply because I feel I can manage the condition without pharmaceutical intervention. That's purely a personal decision for me. I'll let you know what he says.

 

[mcdonagh47]

My doctor keeps asking me to go on metformin, ime so far controlling my T2 with diet alone
Andy

Hi there,

you shouldn't be trying to control your T2 with "diet alone" ; the initial regime is supposed to be diet and EXERCISE. :wink:

What's your HBA1c ? The NICE Guidelines for T2 indicate that medication should start at 6.5 and above.

metformin is hugely important for T2s not least because of its Heart protection qualities ( 80% of us are going to die of Heart disease). Because of its general health benefits One group of medics were suggesting five or six years ago that ALL over 50s should be on it regardless of whether they are diabetic or not !!

Metformin comes pretty close to being the best thing since sliced bread as far as diabetics are concerned.

 

[annew]

mcdonagh47 wrote:
Metformin comes pretty close to being the best thing since sliced bread as far as diabetics are concerned

Sliced bread is actually rather bad for many of us diabetics..........

 

[VinnyJames]

lol - unless its Livlife bread at 3.8g a slice

£1.99 from Waitrose

 

[VinnyJames]

McDonagh, (or anyone familiar with the clinical paper).

Are the heart protection qualities of Metformin an additional benefit on top of diet and exercise in T2 diabetics?

I'm keen to come off it but I want to make sure its the right decision. I see the GP tomorrow (not today as previously stated).

Vinny

 

[VinnyJames]

Just had a quick look at the UKPDS study

http://www.ncbi.nlm.nih.gov/pubmed/9742977/

I know this is an important study for diabetologists but when I checked the different subject groups none were assigned to exercise.

No pharma company is going to publish a study showing exercise is better than metformin BUT is there any other clinical evidence for the heart protective benefits of metformin??

 

[tonyS54]

Iv'e been on metformin for seven years with no problems, I have reduced the dose to 3 x 500mg a day and will drop it down to two shortly but I won't come off it all together because of possible heart benefits it may give.

As an aside one of the problems with long term metformin use could be vitamin B12 deficiency this could happen for those on it for over 10 years, there's an age( 65+) related side to it too, some of the elderly may not be able to absorb enough from dietary sources, they should have B12 monitored regularly if they take metformin.

 

[mcdonagh47]

I'm keen to come off it but I want to make sure its the right decision. I see the GP tomorrow (not today as previously stated).

Vinny

There was a 2008 survey of 40 research papers on metformin.The result was ...
Metformin reduced CV mortality by 26% relative to any other antidiabetic agent or placebo

October 27, 2008 issue of the Archives of Internal Medicine.

 

[PhilT]

http://www.sciencedirect.com/science/ar ... 4397002544 is a fairly straightforward metformin trial looking at dose response in Type II diabetics starting with HbA1c values around 10% and fasting plasma glucose (FPG) around 15 mmol/l.

None of the dose rates up to and including 2500 mg/day improved HbA1c by more than 1% point from baseline.

HbA1c got slightly worse than baseline on 500 mg of metformin (but better than placebo with a bit of statistical adjustment) and at 1000 mg the effect was minimal.

FPG was reduced at all dose rates. Metformin alone doesn't help if you eat carbs all day I guess, but reduces overnight glucose output from the liver.

 

[PhilT]

http://www.nejm.org/doi/full/10.1056/ne ... 8313330902 was the study that led to Metformin being approved in the US

at the end of the study the 143 patients in the metformin group, as compared with the 146 patients in the placebo group, had lower mean (±SE) fasting plasma glucose concentrations (189±5 vs. 244±6 mg per deciliter [10.6±0.3 vs. 13.7±0.3 mmol per liter], P<0.001) and glycosylated hemoglobin values (7.1±0.1 percent vs. 8.6±0.2 percent, P<0.001).

So a 1.5 reduction in HbA1c, with most of them on 2500 mg/day.

In both protocols the patients given metformin had statistically significant decreases in plasma total and low-density lipoprotein cholesterol and triglyceride concentrations, whereas the values in the respective control groups did not change.

 

[hanadr]

Metformin is a pretty safe medication with few side effects. The worst being the famous digestive upsets.Metformin SR is less irritant.
A study comparing Metformin with a placebo, doesn't tell you anything about comparing Metformin to diet and exercise.
If your blood glucose is fairly easy to control, then diet alone may be enough. If you need to be strict on carbs, Metformin will help.
I'm pretty sure that I could manage without Metformin, but I'd have to be 100% on diet. I opt to be about 95% strict and take 2 x 500
mg Metformin per day. that's 10 years after diagnosis.
Essentially everyone must make their own decisions on what suits them and what helps. Even maximum dose Metformin doesn't reduce B G very much, which is why many people move on to other medications.
Hana

 

[Thommothebear]

I was specifically told metformin would have very little direct effect on BG but would reduce spikes and offer other unspecified protection. i'm on 500mg SR daily which is I guess minimum dose anyway -I am pretty good at sticking to my chosen nutritional plan and 110% strict on my exercise plan as in I am inclined to do more than I should rather than less

Apart from the first few weeks on metformin where I had a strange aftertaste, i've had no side effects to speak of.

I'm due another review in a couple of weeks and if they try and take me off metformin I shall be arguing with them.

 

[Bob_RD00752]

I was diagnosed as T2 with low thyroid a year ago with HbA1c 52 and put on metformin and levothyroxine. Having lost around 30 pounds in the last year I was taken off metformin but the levothyroxin was increased (50 to 75 mcg) - HbA1c was last measured at 36. In my case it may be that the low thyroid helped make me lethargic and increased both weight and risk of T2.

I put the improvement down to both diet and exercise. For the last 5 years I've walked an average of 90 minutes briskly 3 times a week. I did find a Wii game called My Fitness Coach to increase exercise on those cold wet days when I wasn't walking. Cheaper than the gym too!

I haven't had an HbA1c since stopping Metformin but I do take some blood glucose readings and these have increased from an average of 5.8 to 6.2 - nothing like the 1.0 quoted in another reply. This may be because the life style changes mean that I'm less insulin resistant than I was a year ago. Current blood glucose level is less than in any of the first 6 months since diagnosis when I was still losing weight gradually.