Tag Archives: metformin

More Patients With Impaired Kidney Function Qualify for Metformin

Posted on July 28, 2016 | Comments Off on More Patients With Impaired Kidney Function Qualify for Metformin

Recently the U.S. Food and Drug Administration revised their guidelines for physicians regarding use of metformin in patients with kidney impairment. This may make more patients candidates for the drug.

Physicians have been advised for years that type 2 diabetics with more than minimal kidney impairment should not be given metformin. Why? Metformin in the setting of kidney failure raises the risk of lactic acidosis.

The traditional test for kidney impairment is a blood test called creatinine. When kidneys start to fail, serum creatinine rises. Another way to measure kidney function is eGFR, which takes into account creatinine plus other factors.

By the way, you can’t tell about your kidney function simply from the way you feel; by the time you have signs or symptoms of renal failure, the process is fairly advanced.

The FDA now recommends not using  metformin if your eGFR (estimated glomerular function rate) is under 30 ml/min/1.73 m squared), and use only with extreme caution if eGFR drops below 45 while using metformin. Don’t start metformin if eGFR is between 30 and 45. Your doctor can calculate your eGFR and should do so annually if you take metformin.

Steve Parker, M.D.

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Metformin: More Effective in Blacks Than Whites

Posted on October 30, 2014 | Comments Off on Metformin: More Effective in Blacks Than Whites

Diabetes Self-Management has some of the details.

The implication is that the genetically determined physiology of black diabetics is different from whites. There could be other explanations, admittedly.

 

Here’s why I bring this to your attention. You don’t see me review many scientific articles involving mice, rats, pigs, or rabbits. In fact, I hardly ever read them. I take care of human patients. I suspect there are too many genetic differences between us and them that clinically pertinent studies are rare.

If you read my blogs carefully, you’ll also note I often hesitate to generalize clinical study results from one ethnic group to others. The different black/white responses to metformin validates my approach.

Type 2 diabetes in whites and blacks may not be the same disease, and it could be different in Asians, Australian aborigines, and North American Native Americans. For that matter, Ethiopian black diabetes may not be the South Africa black diabetes.

You may also be starting to understand why there’s so much confusion about which diabetic drugs are the best. We have 12 different classes of drugs now; what’s best for me may not be best for you.

Steve Parker, M.D.

PS: Type 1 diabetes, on the other hand, is probably more homogenous across ethnic and national boundaries.

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How Does Your Doctor Choose Your Diabetes Drugs?

Posted on December 28, 2013 | Comments Off on How Does Your Doctor Choose Your Diabetes Drugs?
paleobetic diet, low-carb diet, diabetic diet

How about this one?

We now have 12 classes of drugs for the treatment of diabetes. Choosing which ones to use is not always straightforward.

It’s easy for type 1 diabetes: insulin.

Type 2’s have more options. Metformin is the unanimous #1 pick. After that, it’s murky.

I recently reviewed the American Diabetes Association’s Standards of Medical Care in Diabetes – 2014. A type 2 treatment algorithm therein mentions only six of the 12 available classes. This gives you an idea of expert consensus on which drugs to use. The classes are biquanides (metformin), sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, and insulins. This is one reason you don’t see much use of bromocriptine and colesevelam.

The American Association of Clinical Endocrinologists also have a type 2 diabetes treatment algorithm, published in 2013. It also addresses prediabetes and overweight/obesity. You’ll see some of the other classes mentioned. It’s confusing because of abbreviations.

Believe it or not, most doctors want to do what’s right for our patients. We want positive results that reduce suffering and death. Does Big Pharma influence the production of guidelines and individual physician drug choices? If I had to guess, I’d say yes. But I don’t have the resources to investigate that in any depth. I know without a doubt that if I recommend a drug and the patient has a bad outcome, it helps me win the malpractice lawsuit if I’ve recommended a guideline-approved drug. Other docs know that, and it’s one of many factors that influence drug choice. We also consider cost (if you bring it up), convenience, patient preference, what our local colleagues are doing, what other illnesses the patient has, potential adverse drug effects, etc.

We don’t know the long-term adverse effects of many of these drugs. That’s why I favor doing as much as reasonably possible with lifestyle modification, such as diet and exercise, before stacking up multiple drugs. If you need drugs, and most with diabetes do, lifestyle modification can help you minimize drug use.

Steve Parker, M.D.

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