On February 6, 2012, the American College of Physicians (ACP) released a new clinical guideline for the management of diabetes advising physicians to use metformin as monotherapy to treat type 2 diabetes when lifestyle modifications like exercise, diet, and weight loss failed.
The association based its recommendation on a comparative study of the effectiveness of available diabetes drugs. ACP’s study revealed that metformin, alone or in combination with other diabetes drugs, was better in lowering glucose level, HbA1C, cholesterol and triglycerides levels, and body weight. Metformin is actually the only diabetes drug proven not to cause weight gain.
Metformin works by suppressing the production of glucose in the liver. Side effects include lactic acidosis, diarrhea, bloating, chest pain, rash, non-cancerous polyps, heartburn, and muscle pain.
Findings of the Diabetes Prevention Program (DPP), an extensive clinical trial conducted by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) also heralded metformin as the first-line of defense against diabetes as far as pharmacotherapy is concerned.
DPP found metformin to reduce the risk of type 2 diabetes by 31 percent particularly to diabetics ages 25 to 44 years with body mass index of at least 35.
Metformin is prescribed commonly in combination with other diabetes drugs like Actos (Actoplus Met). Actos (pioglitazone) is linked to cardiovascular diseases and bladder cancer. Around 10 thousand lawsuits are awaiting Actos maker Takeda after the U.S. Food and Drugs Administration (FDA) required a bladder cancer warning on the drug’s label and insert.
Yet again, metformin made the headline when another recently FDA-approved diabetes drug has it as an active ingredient.
Newly approved drug Janument XR, manufactured by Merck & Co. Inc., combines Sitaglipatin (Januvia), also from Merck, and extended-release metformin. Labels for Janumet XR include boxed warning for lactic acidosis and contraindications for patients with renal problem, acute metabolic acidosis, and hypersensitivity to metformin. Merck said Janumet XR will be available in pharmacies nationwide several weeks from now. Merck is also the maker and marketer of the painkiller drug Vioxx, which caused more than 160 thousand cases of heart attacks and strokes in the country.
Metformin’s life-threatening side effects are in part influenced by its ability to deplete essential nutrients in the body like Vitamin B12, folic acid, and Coenzyme Q-10.
Vitamin B12 (cobalamin) is a water-soluble vitamin necessary for a healthy brain and nervous system. Aside from taking part in cell metabolism, Vitamin B12 also plays a crucial role in DNA and fatty acid syntheses and energy production. Effects of Vitamin B12 deficiency can cause irreversible damage to the brain and the nervous system.
Folic acid (Vitamin B9) is another water-soluble vitamin essential for the body’s repair and synthesis of DNA. It aids in cell division and production of healthy red blood cells. Vitamin B9 deficiency can lead to loss of appetite, weaknesses, irritability, heart palpitations, headaches, and weight loss.
Coenzyme Q10 is a fat-soluble substance, highly concentrated in liver, heart, and kidney. Deficiency may lead to heart failure, migraine, cancer, cardiac arrest, high blood pressure, periodontal disease, and Parkinson’s disease.
Metformin, though considered the least harmful diabetes drug there is, has its shares of serious risks. Employing necessary lifestyle changes like following a healthy meal plan, exercise program, and commitment to lose the extra weight are still the most effective measure in the management of type 2 diabetes.
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