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Can Metformin be used for more than just diabetes?

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doctor prescribing box of metformin medicineMetformin has a long history as a substance with some medical value. It dates back even before its official recognition in 1918 for its ability to reduce blood sugar levels. Before any medical knowledge about diabetes, herbalists utilized a plant called Galega officinalis (also known as goat’s rue or French Lilac) to treat people who were urinating frequently, which is one of the main symptoms of untreated diabetes. Lately, research has shown that Metformin can be used for more than just diabetes. Insulin is produced in the pancreas and plays a pivotal role in glucose metabolism to release energy. In diabetes, the pancreatic cells cannot produce sufficient insulin or have lost sensitivity to glucose levels, resulting in hyperglycemia (high blood sugar).  When diabetes was identified as a condition, attempts were made using guanidine, a component found in Galega officinalis, to decrease blood sugar levels. However, due to the toxic side effects coming from utilizing unaltered guanidine, prolonged treatment proved unfeasible. This scenario changed in the mid-20th century when scientists found ways of synthesizing newer forms of guanidine. The main benefit of Metformin (now based on synthetic dimethylbiguanide) as a way of treating diabetes came from its lower level of risk of inducing hypoglycemia (low blood sugar) compared to the main treatments of diabetes at that time, which were injectable insulin and sulfonylureas. Metformin lowers glucose levels in three ways:
  • By increasing the sensitivity of pancreatic cells to glucose, allowing them to take up glucose from the bloodstream more effectively.
  • By lowering the levels of glucose being produced in the liver (gluconeogenesis) and switching to using stored sugars for energy
  • By reducing the amount of glucose absorbed from food in the intestines.

Where Metformin shows promise in treating conditions other than diabetes.

Recent research suggests that Metformin, alone or combined with other medications, has value in treating diseases and conditions besides diabetes. While more studies are needed for confirmation, exciting possibilities for Metformin’s potential are emerging globally, including:-
  • Managing chronic liver diseases and cancers. Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths in the US due to rising cirrhosis rates. Metformin shows promise that it can play a preventive role against HCC among patients with diabetes and chronic liver disease, and it should even be continued in diabetic patients with cirrhosis.
  • Improving resistance to the SARS-CoV-2 virus in obese or diabetic female patients to prevent severe COVID-19. One study analyzed information about over 6000 patients who had been hospitalized due to infection with COVID-19. While Metformin was not associated with any significant decrease in mortality overall, among women with type 2 diabetes or who were obese, there was an improved chance of survival when they were being treated with Metformin.
  • Delaying the onset of dementia and Alzheimer’s Disease. Research suggests a link between metformin usage and dementia risk based on data comparisons of patients with diabetes taking metformin and those discontinuing the drug upon signs of kidney disease onset. Results showed an increase of 20% in the incidence of dementia diagnosis among those who stopped taking metformin. Another study involving individuals aged 50 years and above revealed a lower risk of dementia among metformin users compared to those treated with sulfonylurea medications.
  • Reducing the rates of illness and death in individuals with pre-diabetes and existing heart conditions. This is the focus of a prolonged research study just starting because information so far indicates that Metformin shows promise in areas relating to cardiac conditions. While conclusive outcomes are not expected until the end of this decade, the significance lies in addressing heart disease, which stands as the leading cause of death among adults. The potential impact of treatments involving Metformin could be substantial.

Frequently asked questions:

What is the main  function of Metformin?

Metformin aids in regulating blood sugar levels by reducing glucose absorption from food and limiting glucose production by the liver. Additionally, it enhances the body’s responsiveness to insulin, which plays a role in managing blood sugar levels. 

What is Metformin’s role in diabetes treatment?

Metformin received FDA approval for type 2 diabetes treatment in 1994. It has since become one of the most commonly prescribed medications in the United States. In 2021, healthcare providers issued over 90 million prescriptions for this drug, marking an increase of more than 120% compared to 2004. Metformin has been included on the World Health Organization’s list of essential medications since 2011. Metformin impacted diabetes treatment towards the end of the 1990s following the release of a critical study named UKPDS 34 in September 1998. This study focused on assessing the effects of blood glucose control using Metformin in individuals with type 2 diabetes. The aim was to compare Metformin’s efficacy with insulin or sulfonylurea therapy in managing glucose levels in patients and slowing down the progression of the disease to reduce the risk of heart attacks. The key takeaway from UKPDS 34 was that “intensive glucose control with Metformin results in less weight gain and fewer hypoglycemic episodes compared to insulin and sulfonylureas.” The study recommended considering Metformin as the drug therapy of choice for such patients.

What is the biggest side effect of Metformin?

Regarding side effects, prolonged use of Metformin may lead to acidosis, where lactic acid accumulates in the body. While this condition can sometimes occur due to a Metformin overdose, it commonly develops slowly in patients with liver or kidney issues who have reduced acid excretion. The symptoms may include nausea, stomach discomfort, fast heartbeat, low blood pressure, (hypotension), and rapid breathing (tachypnea). Individuals may also experience a deficiency in vitamin B12.

How long can you safely take metformin?

Since there is no direct cure for diabetes, Metformin can be safely prescribed as a good way of controlling blood glucose levels unless there are indications that some side effects outweigh the benefits. The most frequent sign to stop is when the kidneys aren’t functioning correctly. In such a case, doctors often suggest that their patients stop taking Metformin and switch to another medication. However, it’s essential to consult a healthcare professional before discontinuing Metformin.

Does Metformin make you hungry?

No, Metformin does not increase appetite. Studies show the opposite is true: the drug can decrease appetite. This occurs because Metformin enhances the body’s response to the hormone leptin. Leptin plays a role in regulating the balance between food consumption and energy expenditure. It signals when you should stop eating. An increased responsiveness to leptin can lead to reduced feelings of hunger.
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