Weight Loss With Metformin
In individuals who are obese, metformin promotes mild to moderate weight reduction. Sometimes it helps with weight stabilization for patients continuously gaining weight. Compared us to weight gain often associated with insulin or sulfonylurea treatment. In one large study, for example, patients treated with glyburide gained an average of 4 lbs, whereas those receiving metformin lost 6 Ibs.
What Are The Contraindications
We do not use metformin for patients with factors predisposing to lactic acidosis.
These predisposing factors for lactic acidosis/contraindications are:
Significantly impaired renal function Active or progressive liver disease Active alcohol use Unstable or acute heart failure. History of lactic acidosis during metformin therapy The patient comes in the hospital with low blood pressure problems.
Cancer is not a contra-indication for metformin.
The exact degree of kidney, heart, and liver function required for the safe use of metformin is uncertain. Improved clinical outcomes with metformin have been reported in observational studies of patients with diabetes and heart failure, mild kidney impairment , or chronic liver disease with hepatic impairment. Seventeen observational studies comparing regimens with and without metformin, metformin use showed a reduction in mortality rate among patients with heart failure, kidney impairment, or chronic liver disease. Besides, metformin use in patients with renal impairment or heart failure led to possible fewer heart failure readmissions.
Our approach to the administration of metformin:
For patients with an eGFR <30, we do not prescribe metformin. When EGFR 45, we prescribe full dose. For patients with an eGFR of 30 to 44 and in the absence of active kidney, we do not use more than 1000 mg of metformin a day. On the other hand, lower doses of metformin may not produce the desired effect of glucose reduction.
Clinical Benefits In Diabetes Mellitus Type 2
Metformin acts primarily in the liver by reducing glucose output and also by enhancing peripheral uptake of glucose, mainly in muscles. It is not generally associated with a risk of hypoglycemia unless there is excessive exercise, severe calorie reduction or when mixed with other antidiabetic medicine. There is absence of weight gain along with modest reductions in triglycerides . It causes a reduction in mortality by decreasing cardiovascular complications .
Metformin has shown some effectiveness in polycystic ovarian syndrome, some gynecological cancers, nonalcoholic fatty liver disease and for premature puberty. However, its main role remains in the management of diabetes mellitus type 2 . The International Diabetes Federation lists it as one of the first antidiabetic medicines to be used for DM2 . The World Health Organization lists it as one of two essential medicines for diabetes .
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How Metformin Prevents Kidney Disease Progression
For patients at stage 3B or earlier in their kidney disease, metformin showed a dramatic decrease in their risk of progressing to stages 4 and 5, as well as their overall risk of dying.
The study included 10,426 patients from South Korea with both type 2 diabetes and chronic kidney disease. The patients were followed for 7.5 years.
Can Metformin Lower The Risk Of Cancer
Patients with diabetes may have a 1.5- to 2-fold increase in cancer risk, according to a report from 2010. However, recent research has shown that metformin may be effective in treating and preventing cancer. Studies published in 2018 and 2015 suggest that people taking metformin may have a lower risk for cancer, with some studies suggesting a reduced risk of 30% to 50%.;
How does this work? Some researchers have suggested that metformin slows or stops tumor cell growth. However, this research is still limited. Its also hard to tell if metformin itself lowered cancer risk in the supporting studies because other treatments and interventions may have been involved. Its unlikely that metformin will be prescribed to treat cancer at this time based on the currently available data.
The bottom line
Most of the myths regarding long-term, negative side effects of are not cause for concern. However, some side effects, like anemia, are worth being aware of. Metformin can also cause short-term side effects like stomach discomfort.
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Demographic Medical And Laboratory Data Collection
Demographic and medical data including age, gender, comorbid conditions involving hypertension, ischemic heart disease, heart failure, cerebrovascular disease, peripheral arterial occlusive disease, and liver cirrhosis, and medications including anti-hypertensive agents, anti-diabetic agents, lipid-lowering agents, non-steroidal anti-inflammatory drugs, and selective COX-2 inhibitors were obtained from the research database of KMUH. Baseline laboratory data including blood fasting glucose, serum triglycerides, serum total cholesterol, serum LDL-C, serum high-density lipoprotein cholesterol, HbA1c, eGFR, serum creatinine, serum uric acid, and UACR were also collected. eGFR was calculated using the four-variable equation in the Modification of Diet in Renal Disease study.
How To Tolerate Metformin
Some patients may have gastrointestinal intolerance to metformin such diarrhea and bloating. In these patients, slower titration, ensuring that the patient is taking the medication with food, or switching to an extended-release formulation may improve tolerability. Extended-release metformin Extended-release metformin, typically taken once daily with the evening meal, is available in 500 and 750 mg tablets. For our patients having tolerance problems, we sometimes give the entire dose up to 2000 mg at once at the dinner meal. Because patients take metformin with meals, the ability to administer the whole treatment once daily typically improves adherence.
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How Much Do You Know About Metformin
Metformin is a drug commonly used in the treatment of Type 2 diabetes. It is sold as a generic and under several brand names, including Glucophage, Glumetza, Riomet, and Fortamet. Both the American Diabetes Association and the American Association of Clinical Endocrinologists recommend metformin as a cornerstone of therapy for Type 2 diabetes when exercise and dietary changes arent enough to keep blood glucose levels in target range. The low cost of the generic forms along with a long history of use make it a good choice for many individuals with Type 2 diabetes.
Although metformin has helped many people lower their blood glucose levels, it does have some potential side effects that are worth knowing about. Understanding the risks and benefits of metformin is key to using it successfully. Take this quiz to test your knowledge of this popular diabetes medicine.
1. How does metformin work to lower blood glucose levels?A. It stimulates the pancreas to make more insulin.B. It decreases the amount of glucose produced by the liver and makes it easier for cells to accept glucose from the bloodstream.C. It slows the digestive systems breakdown of carbohydrates into glucose, allowing more time for insulin to work.D. It suppresses appetite, slows stomach emptying, and inhibits the release of glucagon .
2. In addition to lowering blood glucose, metformin sometimes causes moderate weight loss.TRUEFALSE
Common Diabetes Drug Found Safe For Most Diabetics With Kidney Disease
Acidosis related to use of metformin seen only in those with severely decreased kidney function
Oral diabetes drug metformin is safe for most diabetics who also have chronic kidney disease .Credit: Johns Hopkins Medicine
A report on the study appeared online June 4 in;JAMA Internal Medicine.
Metformin is the first-line medication for treatment of type 2 diabetes in adults and the fifth most commonly used drug in the United States. However, there has been a longstanding concern in the medical community about prescribing metformin for people with both diabetes and CKD because it may cause lactic acidosis, says senior study author;Morgan Grams, M.D., Ph.D., M.H.S., an associate professor of medicine and epidemiology at the Johns Hopkins University School of Medicine. Lactic acidosis is a rare but serious complication, occurring when lactatea product of glucose breakdownbuilds up in the bloodstream, producing symptoms such as severe muscle pain, cramps, nausea and weakness. Because patients with CKD may be at increased risk of metformin-associated lactic acidosis, health care providers historically avoided prescribing metformin in this population.
The research team used computer-based statistical models to analyze the risk of developing acidosis among metformin users compared with nonusers. The researchers adjusted for conditions such as cardiovascular disease and smoking status.
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What Are The Long
Metformin is a prescription drug that is used to help control blood glucose levels in individuals with type 2 diabetes mellitus 1.It is commonly sold under the brand names Glucophage and Fortamet and is available in regular and slow-release tablets. Metformin works by acting on the liver and intestines to decrease secretion and absorption of glucose into the blood 1. It also increases the insulin sensitivity of muscles and tissues of the body so that they take up glucose more readily. MayoClinic.com underlines that as with any medication, metformin can cause unwanted side effects that may be common or more serious 12.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Some Side Effects Can Be Serious If You Experience Any Of These Symptoms Or Those Listed In The Important Warning Section Call Your Doctor Immediately Or Get Emergency Treatment:
- chest pain
- rash
Metformin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
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How Should This Medicine Be Used
Metformin comes as a liquid, a tablet, and an extended-release tablet to take by mouth. The liquid is usually taken with meals one or two times a day. The regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow metformin extended-release tablets whole; do not split, chew, or crush them.
Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1â2 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working.
Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor.
Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
A Patients Experience With Metformin And Bathroom Emergencies:
Q. I was on metformin for years with no problem. Then my dose was increased, and I started to have colon spasms and extreme bathroom urgency.
The doctor prescribed meds to manage that, but this wasnt perfect. I started to stay home and skip a lot of activities.
My physician took me off metformin and the GI drugs, and now Im fine. Its much better not to worry about bathroom emergencies.
A. Digestive problems including diarrhea are not uncommon with metformin. The extended release formulation seems less likely to cause this problem. In addition, taking metformin with a meal may help.
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Is Metformin Safe In Patients With Ckd
Metformin is currently recommended as a first-line therapy for treatment of type 2 diabetes mellitus because of its low cost, side-effect profile, and possible systemic benefits. Despite these advantages, cautious use of metformin has been recommended by the US Food and Drug Administration in patients with chronic kidney disease due to safety concerns, including risk for lactic acidosis. Specifically, the label states that metformin is contraindicated at an estimated glomerular filtration rate < 30 mL/min/1.73 m2, and it is not recommended to initiate metformin at an eGFR < 45 mL/min/1.73 m2.
Despite these recommendations, the data on the risk for lactic acidosis in patients with CKD on metformin have been conflicting; some studies have shown increased risk while others have not. A recent large study that was published in JAMA Internal Medicine was conducted to better understand the risk for lactic acidosis in patients with CKD using large clinical datasets and sophisticated statistical methodology.
Metformin Use and Risk for Lactic Acidosis
In this paper, the authors studied a community-based cohort of patients with a diagnosis of diabetes mellitus and a postdiagnosis serum creatinine measurement who were receiving care in the Geisinger Health System. Metformin use and dose were determined from electronic prescription records.
Where Does This Study Leave Us?
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Tables
What Happens After Starting Metformin
After a successful initial response to metformin, the majority of patients fail to maintain glycemic targets. After a while, they require the addition of a second oral or an injectable agent. For patients who fail initial therapy, many medication classes are available. We frequently use other medications in addition to metformin if diabetes control is not adequate. We continue to monitor kidney function. If kidney problems happen while on metformin, we change the dose or stop the medication. We will discuss more below, yet most patients with cancer can use metformin safely as long as they have okay kidney and liver function.
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What Happens During Your Metformin Lawsuit
A court case is usually started by a plaintiff demonstrating severe, long-term damage as a result of the drugs use. The court then looks at what level of those damages are spelled out in the drugs labeling, and decides whether those damages are enough to hold the drug company responsible.
If the court agrees that the drug manufacturer has a liability, it will ask a jury to determine just how much compensation should be awarded to you. That jury will make up an amount of damages to send back to the drug company, and then the case will end. If the drug manufacturers insurance carrier or some other entity covers the damages, that company isnt responsible for them. If they dont, then youll be on your own.
A great resource for researching a kidney damage lawsuit related to metformin is the Internet. A quick search will yield pages of articles written on this topic. Of course, its always a good idea to speak to a qualified attorney before proceeding with a legal matter, but speaking to others who have been through the process can be very helpful. It can also give you some first-hand knowledge about the process.
Does Metformin Cause Heart Attacks Or Is It Good For The Heart
Metformin does not cause heart attacks, and it appears to decrease cardiovascular events in specific populations.
In the United Kingdom Prospective Diabetes Study , obese patients who were assigned initially to receive metformin rather than sulfonylurea or insulin therapy had a decreased risk of heart attacks and mortality. In another trial, 390 patients treated with insulin were randomly assigned to metformin versus placebo After four years, average A1C and body weight were significantly lower in the metformin group. Also, there was a decrease in the risk of heart attacks. In other observational studies, metformin showed lower long-term cardiovascular mortality compared with a sulfonylurea .
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Change In Best Practice Treatment
Until now, the FDA has actually cautioned against prescribing higher doses of metformin to patients with kidney disease because of a potential increase in lactic acidosis, which would further stress the kidneys.
This new research suggests that patients in the earlier stages of kidney disease could benefit from metformin without seeing an increase in lactic acid levels.
Only one participant in the entire study experienced an event related to high levels of lactic acidosis directly related to metformin use
The findings are reassuring that the risk of lactic acidosis is very low even in stage 4 CKD, added the studys authors.
There is increasing evidence that treatment with metformin in patients with mild to moderate CKD is safe and may also confer a survival benefit, said expert Samira Bell, MB, a consultant nephrologist at the Renal Unit of Ninewells Hospital in Dundee, UK.
However, randomized controlled trial evidence is required before the widespread use of metformin in patients with eGFR < 30 mL/min/1.73m2 can be recommended.;
Fda Revises Recommendation For Metformin Use In Patients With Chronic Kidney Disease
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Metformin Is Not Usually The Cause Of La
Diabetes mellitus per se disposes to hyperlactemia, the concentration of lactate being double the level of healthy controls , and physical exercise in untreated T2DM causes a 2.8 times increase in p-lactate, similar to metformin-treated patients . Ketoacidosis is commonly accompanied by LA . The increased LA rates seen in patients with heart failure can be related to poor circulation, and, in patients with hepatic failure, to reduced hepatic metabolism of lactate. A controlled investigation showed no increase in lactate concentration or turnover in metformin-treated patients .