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Friday, March 26, 2010

Metformin Started At Diagnosis Far More Effective Than Metformin Prescribed Later

Page Changed: Metformin

A study published of 1,799 Kaiser patients who were able to lower their A1c below 7.5% using Metformin found that when patients were started on Metformin immediately after diagnosis, they were able to stay at an A1c lower than 7% for longer than did patients whose doctors waited a year before starting them on the drug.

Secondary Failure of Metformin Monotherapy in Clinical Practice
Jonathan B. Brown. Diabetes Care Diabetes Care March 2010 vol. 33 no. 3 501-506 doi: 10.2337/dc09-1749

A more detailed discussion of this study can be found here:

Diabetes in Control: Early Treatment Doubles Chance of Success for People with Diabetes

This is important. Many people with diabetes resist taking a drug thinking that it is better to attempt to lower blood sugar with diet or exercise alone. Because the action Metformin is different from the effect of cutting carbs or exercising, this may be a mistake. It may be better to start metformin along with other approaches as soon as you receive a diagnosis of abnormal blood sugar (including a diagnosis of pre-diabetes) rather than waiting.

6 comments:

pjnoir said...

I'm sure you explained this before:
"Because the action Metformin is different from the effect of cutting carbs or exercising" How so?

Jenny said...

Metformin switches the body into a fat burning mode that you achieve with exercise only for an hour or two but with metformin it stays permanently on. Also metformin seems to block the liver from dumping glucose which you can't do even with diet. And it has subtle affects on appetite which may have to do with how it changes the balance of various hormones and affects the hypothalamus.

Some details of what it does (mostly to AMP-Kinase) are described on the Metformin page linked from this blog page.

pjnoir said...

The AMP-Kinase post was an eye opener. I went about a yr and a half without any meds after my insurance company refuse to supply Glucophage. Generic Glucophage ( not the active ingredient Metformin made me very sick. So it was low carb and kettlebells with wonderful success. I got the Riomet that the insurance will supply. I now see the metformin as an ally not as an excuse to eat carbs on an ADA diet plan. Good Stuff Jenny

Pinkish said...

I just started on Metformin ER about a week ago. I've noticed that since I've been on this pill, after exercise my glucose levels increase and they are also higher in the morning. I feel like my sugar was doing better dieting and exercising. I'm still confused as to how this drug works because it seems to have reversed effects.

dermot said...

My doc is an early interventionist and started me on Met at prediabetes diagnosis 3+yr back and 'ahem' encouraged me to lose 40Kg in weight. Ramped up to 2000mp/day of Met over 1st month. My A1C stays between 4.7 and 5.2; 2hrPP is always under 5.0 but a few months ago occasional high fasting and PP - especially if the PP was a bit later than 2hr. Turns out my IR seems to have improved to the point that I was getting a rebound in glucose from my liver due to the Met being a bit too effective when I dropped to as low as 3.6 occasionally. Cut Met to 2x425mg daily 2 months back and todays A1c is 5.0 but no more rebound highs - standard deviation of my PPs and fasting was .5 due to the bounces, but now is 0.1, so my graph is now very smooth. Doc has asked if I'd like to come of Met entirely, but bearing in mind the various protective effects of Met and my desire not to spoil things, have decided to stay on it. Have you ever come across the effect of rebound in T2 due to Met dosage being a bit too high?

Jenny said...

Dermot,

I haven't had anyone report that rebound effect with Metformin, but it is a known thing that happens with too much basal insulin.

So if your blood sugar has normalized, metformin's ability to keep the liver from dumping glycogen might lead to lows which would lead to the release of stress hormones to respond to the low.

It is possible to stop metformin for a while and go back onto it if you see your numbers slip. I've done that several times myself. I think it might be a healthy thing to do, after reading up about what Metformin does to AMP-Kinase, because I'm not 100% convinced it is good to have it cranked up all the time if you don't have to.