Latest news with #metformin
Medscape
21 hours ago
- Business
- Medscape
Hospital Admissions Similar With Commonly Used T2D Regimens
One third of patients with type 2 diabetes (T2D) treated with metformin plus one of four common glucose-lowering drugs (insulin glargine U-100, glimepiride, liraglutide, or sitagliptin) experienced hospitalization over a 5-year period, with a small but significant benefit observed with liraglutide over glimepiride. METHODOLOGY: The phase 3 GRADE (Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study) trial compared the effectiveness of several classes of glucose-lowering medications by randomly assigning 5047 patients with T2D of less than 10 years' duration being treated with metformin and A1c levels of 6.8%-8.5% to receive insulin glargine U-100, glimepiride, liraglutide, or sitagliptin. Because patients with diabetes require acute medical care — including emergency department visits and inpatient hospitalizations — more frequently than those without, researchers conducted a secondary analysis of the GRADE trial to examine the association between assigned treatments and the risk for incident or recurrent hospitalization over a mean follow-up of 5 years. Participants were monitored quarterly for hospitalization (defined as inpatient admission ≥ 24 hours). TAKEAWAY: Overall, 1636 (32.4%) participants (mean age at baseline visit, 59.7 years; 32.6% women) were hospitalized at least once, with 751 (14.9%) hospitalized more than once during the study period. Compared with patients who were never hospitalized, those who were hospitalized were older, more often men, more often White, less often Hispanic, and more likely to have a history of hypertension and had a higher baseline body mass index. The rates of initial and subsequent hospitalizations were similar across the four treatment groups; however, when the analysis was restricted to participants who received at least one dose of the assigned medication and attended at least one visit after randomization (N = 4830), those treated with liraglutide had a 22% lower risk for the incidence of first hospitalization than those treated with glimepiride ( P = .022). = .022). Factors associated with an increased risk for future hospitalizations were A1c > 7.5%, the number of prior hospitalizations, and changes in the assigned treatment ( P < .001 for all); initial assignment to liraglutide vs glimepiride reduced the hospitalization risk by 13%. IN PRACTICE: 'Deteriorating glycemic control (reaching the secondary metabolic outcome) increased the risk for hospitalizations and highlights the substantial medical burden of type 2 diabetes and continued need for more effective and more durable glycemic control strategies,' the authors wrote. SOURCE: This study was led by Daniel S. Hsia, MD, Pennington Biomedical Research Center, Baton Rouge, Louisiana. It was published online on May 27, 2025, in Diabetes Care . LIMITATIONS: The stringent inclusion criteria limited the generalizability of the findings. The results represent a narrow range of drugs and may not apply to newer and increasingly common medications, such as sodium-glucose cotransporter 2 inhibitors and weekly glucagon-like peptide 1 receptor agonists. DISCLOSURES: GRADE was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, with additional support from the National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention. The Department of Veterans Affairs provided resources and facilities. Some authors reported receiving grants, consulting fees, and payments and having contracts and other ties with multiple pharmaceutical companies and institutions.
Medscape
a day ago
- Health
- Medscape
Continuing Metformin Reduces PCOS Pregnancy Risks
Continuing metformin throughout the first trimester in women with polycystic ovary syndrome (PCOS) showed the potential to reduce miscarriage risk (odds ratio [OR], 0.64) and increase clinical pregnancy rates (OR, 1.57) compared with placebo. A meta-analysis of 12 randomized controlled trials involving 1708 women suggested that stopping metformin at pregnancy confirmation might be less beneficial than continuation through the first trimester. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of randomized controlled trials evaluating metformin started preconception and continued at least until positive pregnancy test compared with placebo or no treatment in women with PCOS. The analysis included 12 trustworthy studies with 1708 participants, with trials conducted across 14 countries spanning five continents, all graded as low to moderate quality evidence. The primary outcome measure focused on miscarriage rate, defined as pregnancy loss prior to 20 completed weeks of gestation, while secondary outcomes included clinical pregnancy and live birth rates. Investigators performed indirect comparisons between treatment groups using the Bucher technique to evaluate clinical pregnancy, miscarriage, and live birth rates for metformin treatment continued throughout first trimester vs stopped at a positive pregnancy test. TAKEAWAY: Women receiving preconception metformin continued throughout the first trimester had higher clinical pregnancy rates (OR, 1.57; 95% CI, 1.11-2.23), potential reduction in miscarriage (OR, 0.64; 95% CI, 0.32-1.25), and possible increase in live birth (OR, 1.24; 95% CI, 0.59-2.61) compared with placebo or no treatment. Participants who stopped metformin once pregnant showed an increased clinical pregnancy rate (OR, 1.35; 95% CI, 1.01-1.80) but suggested higher miscarriage risk (OR, 1.46; 95% CI, 0.73-2.90) compared with placebo or no treatment. Indirect comparisons consistently favored continuing metformin through first trimester vs stopping at pregnancy confirmation for clinical pregnancy (OR, 1.16; 95% CI, 0.74-1.83), miscarriage (OR, 0.44; 95% CI, 0.17-1.16), and live birth (OR, 1.14; 95% CI, 0.41-3.13). IN PRACTICE: 'Women with PCOS have been shown to have a fivefold increased risk per year of developing insulin resistance and subsequent type 2 diabetes. Insulin resistance has been shown to be independently associated with a higher risk of miscarriage. Metformin acts by decreasing gluconeogenesis, lipogenesis and enhancing glucose uptake, all of which in turn reduce insulin resistance,' wrote the authors of the study. SOURCE: The study was led by James Cheshire, PhD, Birmingham Women's and Children's NHS Foundation Trust in Birmingham, England. It was published online in American Journal of Obstetrics and Gynecology . LIMITATIONS: According to the authors, the main limitation was the inherent heterogeneous nature of the study population and the overall low quality of evidence. Women with PCOS have different phenotypes and varying degrees of hyperandrogenism and insulin resistance, which could not be accounted for in the analyses. Additionally, many studies did not subdivide pregnancy outcome data by body mass index (BMI), preventing meaningful analyses in BMI subgroups. The limited outcome data in spontaneously conceiving populations (only 30 women from two studies) make it difficult to extrapolate findings to this group. DISCLOSURES: The authors reported having no conflicts of interest. The study received no external funding.
Daily Mail
3 days ago
- Business
- Daily Mail
EXCLUSIVE Researchers prove Joe Rogan's theory about 20-cent wonder drug taken by millions of Americans is correct... as colon cancer link emerges
A cheap drug often promoted by podcaster and fitness fanatic Joe Rogan could lower the risk of colon cancer. A new study found metformin - a 20-cent pill used to manage type 2 diabetes - cut the risk of developing the deadly disease by up to 13 percent. Your browser does not support iframes.
WebMD
16-05-2025
- Health
- WebMD
What Friends Ask Me About Diabetes
As someone who was diagnosed with gestational diabetes in 1984 and full-blown diabetes not long after my second pregnancy in 1992, it's easy to forget the shock of first getting the news that you have type 2. As I've written before, I went home from that first doctor's appointment stunned and scared, worried not only about myself, but my unborn child. But in the years since, as I've lived and learned more about the symptoms and signs of the chronic disease and how my body reacts to carbohydrates, exercise, and medication, my fear has eased. It was replaced by a desire to figure out the best way to live as a person with diabetes. It hasn't been easy. I'm not always successful at keeping my sugars in range, or in avoiding foods that I know will boost my readings (I'm looking at you, Haagen Dazs chocolate chip). Yet, overall, I have headed off many of diabetes' dreaded complications so far (knock on wood) and generally feel able to do most of my normal activities, which include weightlifting, walking, and cycling. I was reminded of all of this when a friend came to me, newly diagnosed with LADA (latent autoimmune diabetes in adults) and frightened by the idea of having to wrestle with the disease. Meanwhile, a second pal, who has been prediabetic for a while, suddenly was confronted by an A1c of 7, which pushed her into full-blown type 2. Despite their two different varieties of diabetes diagnoses, both had been advised to watch their diets and given prescriptions of metformin to help lower their glucose levels. Though they had met with their doctors, they had questions. And while I'm not a medical doctor, I tried to allay some of their fears. Among their issues: Should I take a biguanide? Everyone is, of course, different. I've had friends who don't take them right away and try diet and exercise, and those who choose to go on them when they are still considered in the 'prediabetes' stage. As someone who has been taking them forever, I'm a fan. They're cheap, extremely well-tested, and may have other benefits in preventing breast cancer as well as anti-aging properties. Although I've never experienced side effects, at the start some people experience upset stomachs, but generally, it's worked well for me. Do I have to live this way forever? Some people, by severely restricting carbohydrates and adding lots of exercise to their lives (particularly if they had been overdoing food and not exercising beforehand) may be able to 'reverse diabetes.' But while I follow a balanced, mainly low-carb diet and get an hour of some sort of exercise every day, that hasn't happened for me. As a person with type 2 diabetes who has never been overweight (save for a year after the birth of my second child when those pesky pounds refused to move), I still have well-controlled type 2. Do you ever get used to pricking your finger two, three, or four times a day? Yes, and no. To be honest, I don't think anyone loves stabbing themselves to squeeze out blood in the morning, noon, or night. Luckily, there are new technologies that measure your blood sugar for you and give you a more accurate ongoing idea of your glucose ups and downs over a day and night. I've not yet opted for one, but more and more, I see the small, unobtrusive stick-on cubes on the upper arms of both young and old people. So if mechanically drawing a drop of blood from your finger freaks you out, you do have options. Will I eventually have to take insulin? Once again, it depends. With the newer injectable diabetes drugs on the market – and a weight loss pill waiting in the wings – people who once couldn't lose pounds or lower their blood sugars may be able to avoid insulin by getting everything in better range. For people with LADA, the chances of needing insulin are higher, since in this form of diabetes, the pancreas stops making insulin, more like type 1 than type 2. Two personal notes here: I took insulin during my second pregnancy, and it really was not a big deal. It allowed me to better manage my sugars, and by using fast-acting insulin, I was able to eat the occasional cup of ice cream. Unless you have a terrific fear of needles, insulin pens are quite small and go into fat, not muscle, which means they are not – honestly – at all painful. What else? Watch out for stress. Sometimes, your sugar can be high without reason, and sometimes, it can go low. The more you pay attention to your patterns (Does it jump after eating a certain fruit? Does it drop after a particular exercise class?), the more you can try avoiding these extremes. Getting a diagnosis of type 2 diabetes is scary. But with new drugs, new technologies, and a little attention to your diet and exercise, you can fight the fear and take charge. Like I tell my friends, it's not easy, but well worth it.
Medscape
07-05-2025
- Health
- Medscape
What's Your Go-To Treatment for New Diabetes Patients?
For years, metformin has been the go-to first-line oral medication for patients newly diagnosed with type 2 diabetes. But with the growing popularity and effectiveness of medications like semaglutide (Ozempic) and tirzepatide (Moujaro), that's changing — and so are guidelines and recommendations. Now primary care providers have a decision to make: What's the best first-line treatment for these patients and what factors contribute to that choice? First Up: Metformin For many patients newly diagnosed with type 2 diabetes, lifestyle changes, including improvements to diet and embracing regular exercise, are the first step in the effort to get their blood glucose levels under control. 'Usually the decision to start oral medications is largely dependent on how bad the diabetes is,' said Jay Shah, DO, a primary care physician with Pomona Valley Hospital Medical Center in Pomona, California. Physicians have long relied on metformin as their first-line medication for treating type 2 diabetes, usually in conjunction with lifestyle changes. The US Food and Drug Administration first approved this antidiabetic agent in 1994 and it quickly took off. By 1995, it was already widely prescribed for type 2 diabetes management. According to a 2021 study that reviewed data from two large US health insurance databases, metformin was used by 80.6% of Medicare beneficiaries and 83.1% of commercially insured patients in the period between 2013 and 2019. The authors noted that the use of glucagon-like peptide 1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter 2 (SGLT-2) inhibitors was low but was increasing among patients with cardiovascular disease. Some physicians say that they still turn to metformin first. 'The usual first-line treatment is still the oldie-but-the-goodie, metformin,' said Neal H. Patel, DO, a family medicine physician with Providence St. Joseph Hospital Orange in Orange, California. 'It is probably the most commonly prescribed drug in the world for diabetes and usually is great because it targets the cause of diabetes, which is insulin resistance rather than high blood sugar.' However, he added, he does take a patient's kidney function into account, noting that lactic acidosis is a rare but possible complication of metformin use. Asha Shajahan, MD, also regularly turns to metformin. 'Usually I do metformin because it's the easiest,' said Shajahan, a primary care physician with Corewell Health in Roseville, Michigan. 'It's pretty effective, and you don't have to be so concerned with your sugars dropping.' An exception would be a patient with very high blood glucose levels. In that situation, Shajahan would start them on insulin right away and follow them closely until they are stabilized. The Rise of GLP-1s and SGLT-2s In 2021, a study published in the journal Therapeutic Advances in Endocrinology and Metabolism asked 'Should metformin remain the first-line therapy for treatment of type 2 diabetes?' Asha Shajahan, MD The study's authors acknowledged that metformin is effective and well-tolerated in the treatment of type 2 diabetes but noted there's little data about whether metformin confers any cardiovascular benefits. Meanwhile, GLP-1 RAs and SGLT-2 inhibitors can provide additional protection from diabetes-related complications, such as cardiovascular and renal disease. With data that shows these other anti-hyperglycemic medications provide additional benefits in certain populations, the authors asked if healthcare providers should continue to rely on metformin as the first-line treatment. 'You don't necessarily have to try metformin right away,' said Betul Hatipoglu, MD, an endocrinologist, professor of medicine, and director of the Case Center for Diabetes, Obesity, and Metabolism at Case Western Reserve University School of Medicine in Cleveland. 'Some people still use it as it's cheaper. And that's okay. I'm not saying that's wrong.' Betul Hatipoglu, MD But, she added, a physician could go ahead and start the patient out on a GLP-1. If the patient is struggling with obesity and research suggests that losing 5%-10% of their body weight could help them go into remission, 'why not give them something from the get-go that could help them?' Shajahan agreed that she might recommend starting with a GLP-1 to patients newly diagnosed with type 2 diabetes who have struggled with being overweight or obese for many years. 'Those are the people that I tend to be more like, 'The GLP-1s are better for you,'' she said. Guidelines have shifted to reflect the new landscape. In 2021, the American Diabetes Association (ADA) updated its guidelines to 'elevate the use' of GLP-1 RAs and SGLT-2s to reflect their benefit for patients with cardiovascular and renal comorbidities. Then in 2022, the ADA and European Association for the Study of Diabetes published a joint report that removed metformin as the only first-line agent and added that GLP-1 RAs or SGLT-2s could be first-line options in patients with cardiovascular and renal disease. Zoovia Aman, MD, a family medicine physician with Medstar Health in Silver Spring, Maryland, considers the safety, effectiveness, price, and simplicity for her patients with type 2 diabetes when choosing a medication. Although she noted that metformin is safe and well-tolerated by most, she does also consider their kidney function. If their creatine levels are elevated, she might bypass metformin. 'Patients which have high cardiovascular risk or have known cardiovascular disease, I usually prescribe GLP-1s if their insurance does cover it,' she said. Cost Is Still a Factor However, physicians say they still have to consider a factor beyond which drug will help their patients most: Cost. The Therapeutic Advances in Endocrinology and Metabolism study authors noted in their conclusion that cost was a barrier for many people when it came to certain glucose-lowering medications, such as GLP-1 RAs and SGLT-2 inhibitors. That's still the case for many patients, as the 2024 study titled 'Impact of cost on prescribing diabetes medications for older adults with type 2 diabetes in the outpatient setting' in Research in Social and Administrative Pharmacy cautioned. Neil Soskel, DO, a family medicine physician with Mount Sinai in Lynbrook, New York, said he will typically prescribe a GLP-1 RA or SGLT-2 inhibitor if a patient has insurance that will cover it, especially if they have a higher body mass index and other comorbidities. But it's not always easy. 'With most of the insurance companies, it's still a battle, or the copayments are still so high,' he said. Neil Soskel, DO According to Soskel, it's been a particular struggle for his Medicare patients. Medicare does allow coverage of Ozempic for patients diagnosed with type 2 diabetes and cardiovascular disease through Medicare Part D coverage, but the coverage depends on whether the medication is covered in the patient's specific formulary. Absalon Gutierrez, MD, an endocrinologist at UT Health Houston in Houston, said metformin is still a good place to start if a patient doesn't have insurance coverage for a medication like Ozempic or Mounjaro. But if they do have coverage, he would recommend a GLP-1 for a patient with known heart disease or kidney disease, or perhaps an SGLT2 inhibitor. 'That's another good option,' he said. 'They won't lose as much weight with that one, but it's a good option.'
