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Since Glucophage's (metformin) arrival on the U.S. market in 1995, the type 2 oral medication has produced significant results in people with type 2 diabetes, including reducing fasting glucose levels an average of 60 mg/dl and lowering HbA1c an average of 1 to 2% (i.e., from 10% to 9 or 8%).
Now doctors at the Barbara Davis Center in Denver, Co., want to see if Glucophage can help adolescents with type 1, too.
Felipe Wahlravens, MD, a pediatric specialist at the center, started a six-month treatment study on adolescents after he found a lack of data on Glucophage and type 1s.
"I called the manufacturer and they said there were a few studies that had been done in France 10 years ago," he says. "But these weren't very conclusive because this was before home glucose monitoring or HbA1c testing became widespread."
So far Wahlravens has 42 teens between the ages of 14 and 19 enrolled in the study but would like to test at least 80 altogether. Some are on a placebo and the others are taking 500 mg of Glucophage twice a day. He has seen significant results.
"There's been a 1 to 2% decrease in HbA1c averages and a 30 to 70 mg/dl decrease in blood sugar readings," he says. "But I don't know yet who is on the placebo and who is on Glucophage."
Ryan Dyess, age 15 and a type 1 since the age of 10, hopes Glucophage works. His doctor has had him on two 500 mg tablets of Glucophage twice a day for two months.
Ryan's mother Beverly Dyess is pleased with the results. "After the first month we really started seeing improved blood sugars. His highest HbA1c has been 8.1%."
Ryan's doctor, Henry Artman, MD, a pediatric endocrinologist in Nevada, first heard about the new therapy at a National Cooperative Growth Study Meeting when Wahlravens brought up the positive results he'd seen in Glucophage's effect on adolescents. Artman found his findings significant enough to try the drug out on his own patients. He hopes it will have a positive effect on adolescents like Ryan Dyess; still he is adopting a cautious wait-and-see approach.
"It's certainly not a cure-all," says Artman. "But in patients that are being compliant but still have to keep upping their insulin dosage, it's at least something to try."
One advantage the drug has is that it prevents weight gain. This could be especially helpful for teenage girls who often require large doses of insulin but wind up not taking their insulin in order to lose weight.
In very rare cases, the drug can cause a potentially fatal disease called lactic acidosis. It also should not be prescribed for patients with kidney complications. There have been some minor side effects such as stomach upsets, but this usually passes after a few days.
The drug is an insulin sensitizer and does not act on pancreatic beta cells, so there is no chance that it could wear out the remaining beta cells during a honeymoon period.
If Glucophage does indeed help adolescents, should they take it for the rest of their lives? Wahlravens says he hasn't thought that far into the future yet.
"My ultimate hope is that this will help fight diabetes complications down the line," says Wahlravens. "We're keeping our fingers crossed."
Beverly Dyess is going to keep her son Ryan on Glucophage as long as they keep seeing good results. "It hasn't allowed him to cut back on his insulin yet but it has really improved his blood sugar readings," says Dyess.
Wahlravens' study results will be final by the end of 1998.
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.