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Life With Type 2: In Praise of Metformin


Dec 17, 2013

Patrick Totty

The fellow who writes one of the blogs I visit each morning often features links to articles about the wonders of bacon. Whenever he runs one of these items, showing yet another great thing about pork bellies, he asks, "Bacon: Is there anything it can't do?"

I often think the same thing about metformin, the inexpensive drug that is often the "starter" medicine for people who have been newly diagnosed with diabetes. (It's also a standby for a lot of us type 2s who were diagnosed years ago--10 for me. I take four metformin pills daily, a routine that's as normal for me as drinking my morning coffee and downing a kid's-size aspirin tab.)

So what does metformin do that puts it on a par in my mind with that blogger's esteem for bacon? Here are a few:

It comes at diabetes from a different angle than insulin, the sulfonylureas, or the DPP-4 inhibitors. Metformin makes the liver slow down the production of glucose, and in the process fights inflammation, the diabetes complication that does the most to wreck our organs and cardiovascular system.

The medical community has come to realize that metformin's a wonderful pre-emptive strike against developing full-blown diabetes. Doctors are increasingly dealing with pre-diabetes and metabolic syndrome--a precursor to full-blown diabetes--by prescribing metformin. Such pre-emptive use of the drug marks a trend toward hitting pre-diabetes and newly diagnosed cases of type 2 as hard as possible with early application of as many medical weapons as possible.

It has few side effects. The worst seem to be upset stomachs or intestinal distress. Also, metformin is rarely associated with hypoglycemia, probably the effect that people with diabetes fear most.

It plays well with other medications. Pharmaceutical companies are increasingly combining metformin with other drugs to form powerful new diabetes and pre-diabetes management medications. Examples include:

• MK2, a new drug recently developed in Britain, when combined with metformin forms a "super pill" that scientists think could treat severely obese patients from developing diabetes by preventing insulin-cell burnout. (Yahoo News)

• The drug bromocriptine (brand name Cycloset), in combination with metformin, has been shown to reduce the risk of cardiovascular events in type 2s by 53 percent compared to placebo. (Clinical Endocrinology News)

• In Europe, AstraZeneca/Bristol-Myers Squibb is on the verge of receiving approval to market Xigduo®, a drug that combines the SGLT2 inhibitor dapagliflozin with metformin. (Dapagliflozin works by making the kidneys shunt glucose to the urinary stream rather than reintroduce it to the bloodstream.) Before Xigduo can enter the U.S. market, the FDA has to approve dapagliflozin--an outcome that looks likely in 2014.

Metformin not only helps manage diabetes, it also helps people with diabetes as they deal with other diseases. Results of a meta-analysis published in November in the journal Oncologist shows that cancer patients with type 2 who take metformin have a higher survival rate than type 2s who use other types of diabetes medication. (Medscape)

Like many good things, metformin was worth waiting for. For years, metformin was veiled in obscurity, so its later vindication as a powerful therapeutic tool was gratifying to type 2s. The drug originally was developed in the early 1920s, and for a time seemed to hold one answer to how to treat diabetes symptoms.

But the spectacular success of insulin, discovered in 1921, cast a shadow for years over metformin. By the 1940s, interest in the drug was renewed, but it wasn't until the late 1950s in Europe, the early 1970s in Canada, and mid-1990s in the United States that the drug was introduced (as Bristol-Meyers Squibb's Glucophage) to the market.

Did I mention it's cheap? It's also generic. Metformin is long past the point where the drug company that introduced it to the U.S. market can charge a higher price for it to cover development costs and profits. Now sold under an array of names--Glucophage XR, Carbophage SR, Riomet, Fortamet, Glumetza, Obimet, Gluformin, Dianben, Diabex, Diaformin, Siofor and Metfogamma--metformin, of all the diabetes medications available, is by far the easiest for type 2s to afford.

So, a tip of the hat to the bacon of the diabetes world.


Categories: Bromocriptine, Cycloset, Dapagliflozin, Metformin, MK2, Xigduo



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