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Metformin: Why so Popular?

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Dr. Dubois tells us all about what Metformin does in the body, why it is prescribed so much, and busts some common myths about this medication!

I’m susan dubois i’m an endocrinologist and i work for community care health centers and i support this work mary and i’ve been working together for about 10 years now working with the texas tribe family so i’m glad to be here today metformin why so popular so metformin is often the first drug that doctors prescribe for patients with type 2 diabetes could you

Talk more about what metformin does particularly and why is it so common metformin is one of the oldest oral agents that we have to treat diabetes metformin became on the market sometime in the 1990s metformin addresses insulin resistance and the amount of glucose that comes out of the liver so we’ve talked in this series about the liver a lot and one of the

Main functions of the liver is for glucose storage so when we eat a meal the glucose goes into the liver and then when we’re not eating or fasting the sugar gets uh comes back out of the liver into the bloodstream in people with diabetes for reasons that we don’t understand they tend to sort of dump that sugar inappropriately out of the liver into the bloodstream

Some people will call it the leaky liver but you wake up with a higher blood sugar than you went to bed with and so metformin really tries to lower hepatic glucose production and stop that leaky liver so it’s a very good medication to a lesser extent it is an insulin sensitizer that is it helps our body use insulin more efficiently we have many many decades now

Of safety experience with metformin and that’s why it’s one of our first go-to drugs it’s approved for use in pre-diabetes and diabetes prevention as well as as an adjunct either a first-line therapy or in combination with other things in type 2 diabetes it happens to be very inexpensive and widely available in many forms so in a sense like you’re using metformin

To keep those sugar levels in that range that we want like from anywhere 80 to 100 kind of in that range right our target fasting range is as low as we can get it safely in patients on insulin we will often use that 80 to 130 range because people on insulin are at risk of hypoglycemia if i have a patient who is not on insulin or a sulfonylurea and they’re not at

Risk for low blood sugar i’m perfectly happy for them to have a fasting sugar 65 or 70 which is normal but it’s a little bit low for people who are at risk of low blood sugar right and so what meth forming what are some side effects to keep an eye out for so gastrointestinal side effects are by far the most common and these can vary from a little bit of bloating or

Feeling like your abdomen is a little distended to rumbly tummy to diarrhea and at the terrible end of the spectrum is even incontinence of stool so patients may not want to leave their house because they’re afraid they’re going to have an accident so that’s a terrible consequence but what they do in a very positive thing is they help us keep healthy bacteria

In our gut so our intestinal tract contains many billions of bacteria and most of those are helpful and when we have healthy bacteria inside our our micro biome of our gut we are healthier we have less inflammation and patients who take metformin seem to have a healthier gut biome than patients who don’t and if a person is having side effects how should they

Communicate this to their physician to their provider well first of all i would say anybody having side effects if you’re on a high dose of metformin cut it in half any time you adjust your medication on your own it’s a very good idea to go ahead and call the doctor’s office leave a message with the nurse that i’ve had to change my medicine i want the doctor to

Know because we don’t necessarily always want to wait for that next appointment especially if it’s you know longer than a few days or weeks away if you have to discontinue the medication because you’re having terrible terrible side effects certainly do that and maybe they can prescribe an extended release preparation or a different formulation there is a time when

A lot of my patients who’ve been tolerating metformin for a long time started getting diarrhea it turns out that the pharmacy had purchased a new generic that just wasn’t tolerated the way it was formulated and so we actually said could you please go back to the old manufacturer so always letting somebody know is a good idea especially if you’ve tolerated for a

Long time another thing i’ll say about that is anybody who’s on metformin or another class of medications we call the glp1 agonist those are things like trulicity victoza ozempic siliqua and you have nausea vomiting or diarrhea you should hold the medicine until that episode is over because even though you tolerated the medicine really well before once something

Happens and your tummy is upset taking these medicines can prolong it so i just said just hold it for a few days when you’re back to normal reintroduce it and if the symptoms recur then let your doctor know during that time though if you’re not feeling good and you’ve adjusted your meds you have to follow your blood sugar more closely because your routine is very

Different when your routine is off you need to check more closely so on sick days i’ll usually say check at least three times a day and notify me if your blood sugars are running terribly high certainly if they’re going above 300. so we talked a lot about the short-term effects of metformin what are the long-term effects of metformin if any i’m glad you asked that

Question because so many patients read and hear things on the internet or from friends and family and they say i’m worried i’ve taken this metformin will bad things happen to me over time and there’s absolutely no evidence for that and in fact if we go back to that landmark united kingdom prospective diabetes study that took place over 20 years with a 10-year

Follow-up afterwards patients who were in the metformin group had a 33 lower risk of heart attack and a 27 percent lower risk of death so following people for 30 years actually lowered their risk of dying in a cardiovascular event i think that speaks uh to the safety of the drug one of the reasons why people started asking these questions is there was an earlier

Form of the drug that was taken off the market called phenformin and phenformin was associated with a dangerous acid buildup in the blood called lactic acidosis but people did such a good job educating healthcare system about this risk with metformin that people did not use it in the wrong population so you should not use it in somebody who’s on dialysis or has

Stage four chronic kidney disease for a while we didn’t even use it with earlier stages of chronic kidney disease but we learned it was helpful so over time we know that metformin is one of the safest drugs we can use but when you’re in the hospital because you have something going on often will hold it uh if you get a dye study and like a ct scan will hold it that

Doesn’t mean it’s dangerous it just means we’re taking appropriate precautions to keep our patients safe

Transcribed from video
Metformin: Why so Popular? By UT TX STRIDE