Metformin: The truth


One of the most popular and very useful medications today worldwide is Metformin (Glucophage). This drug, whose molecular formula, C4H11N5, was first synthesized in 1929 and clinically introduced in the late 1950s by Jean Sterne, a French physician, who named it Glucophage, meaning glucose eater. In the United States, this drug was approved for type 2 diabetes by the FDA in 1994 and was marketed as Glucophage on March 3, 1995.

Evidence based clinical practice of today uses Metformin as the first-line oral drug for the treatment of type 2 diabetes mellitus, especially those who are overweight, according to the American Diabetes Association and the American College of Physicians.

In spite of its widespread global use and hundreds of millions benefiting from it, there are misleading and egregious assertions by some manufacturers of alternative herbal preparations for diabetes that Metformin is useless and dangerous. These are irresponsible claims in order for the uninformed and the gullible individuals to buy and use their products instead. These products, which have not been studied by the food and drug administration of the United States, the Philippines, or other countries, could be untested, unrefined, adulterated, contaminated, and are unsafe and possibly toxic in the long run.

How does Metformin work?

Contrary to some understanding, Metformin does not directly lower blood sugar like insulin does. Metformin acts to reduce the insulin resistance of the body cells to allow our own natural insulin to enter the cells to enable normal sugar metabolism. A significant number of type 2 diabetes suffer from insulin resistance that prevents insulin from entering the cells and doing its normal job, so the blood sugar goes up. Metformin reduces the resistance and improves the sensitivity of our body tissues in order for insulin to work more effectively. It also lowers the production of blood sugar in the liver. Again, on its own, Metformin does not cause hypoglycemia (low blood sugar).

Are ampalaya preparations as effective?

No. Ampalaya (bitter melon), a vegetable-fruit dish commonly prepared in Asian countries, has been found to lower blood sugar levels a little,but not significantly enough to be effective in controlling the blood sugar levels among diabetics. In spite of this limitation and lack of efficacy, ampalaya preparations (pills, potions, lotions, teas) are on the shelves of many stores, claiming to lower blood sugar level, aimed at scamming the ignorant and gullible public. This is fraudulent because there have been reports of diabetics who stopped their prescribed medications and took these ampalaya preparations instead and have gone into diabetic comma. While eating ampalaya, a succulent dish, is a good idea for everyone, especially for diabetics, the use of the ampalaya preparations on the market as a substitute for (instead of) the prescription medication for diabetes is very dangerous and could be fatal.

What are the other uses of Metformin?

An amazing versatile drug, Metformin is also used for the treatment of polycystic ovary syndrome, and there are some limited suggestions that it may prevent cardiovascular disease and cancer complications of diabetes. More clinical studies are needed to confirm these. Its use is not linked to weight gain and higher risk of low blood sugar in contrast to the use of sulfonylureas for diabetes. Metformin also modestly reduces LDL (bad cholesterol) and triglycerides. Among obese non-diabetics, Metformin has been observed to be induce some weight loss. There is also a study that suggests Metformin be used as a second-line drug if clomifene treatment fails in the management of infertility among women.

Can Metformin prevent diabetes?

Among those with pre-diabetes, who are at risk of developing full-blown type 2 diabetes, treatment with Metformin has been found to reduce the chances of developing this metabolic disease. The same may be achieved with intensive regimented physical exercise done religiously, at least 20 minutes 5 days a week, as shown by the US Diabetes Prevention Program of lifestyle modification.  This non-medication, exercise strategy, could lower the incidence of diabetes by 58 percent. Medical research on this continues to confirm these findings.

Does Metformin improve longevity?

This wonderful drug appears to increase longevity, at least in mice in the experimental laboratory, by a mean life span of 37.8 percent. Findings like this are extrapolated to be applicable among humans. There is scientific evidence that hyperglycemia (high blood sugar) and hyperinsulinemia (high insulin levels) are significant factors both in aging and development of cancer. The life prolonging effects of dieting (caloric restriction) has been attributed to decreasing IGF-1 (insulin growth factor-1), so eating less than maximal will reduce the need for the body to secrete more insulin and its level would go down, including body weight, and eventually in the long run slowing down aging and cancer risk. As my late teacher, Dr. Fe del Mundo, an internationally renowned pediatrician-scientist who lived to almost 100, still treating patients at age 94, stated, her secret to longevity was to push herself “away from the dining table less than full.”

What are the side effects of Metformin?

Metformin is well tolerated by most. Mild diarrhea is the usual initial side effect that is transient, which stops after a day or so. Nausea, abdominal pains, flatulence have been reported but they are mild and temporary. If taken in overly large doses, it causes high blood lactic acid level. This drug is contraindicated among those with kidney or liver disease. Long term use of Metformin leads to vitamin B-12 deficiency, and increase in the homocysteine level, which increases the risk for hardening of the arteries. Vitamin B-6, B-12, and Folic Acid might be considered by the attending physician for these. Among pregnant women with gestational diabetes, insulin is the preferred treatment, although there is no clear evidence that Metformin causes harm among these patients. If the side effects continue for days, which is not common, medical consultation is advised.

Is it safe to self-medicate with Metformin?

As a rule, it is never safe to self-medicate or share medications with anyone, even with over-the-counter drug, unless prescribed by a physician. Allergy and unexpected untoward reactions, side effects, and unforeseen complication, sometimes fatal, can occur in some individuals. Metformin and all other medications must be taken under the guidance of a physician, who knows your personal circumstances and health.

***

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA,  a 501(c)(3) humanitarian foundation in the United States. Email: scalpelpen@gmail.com

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