Tag: metformin

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Check Vitamin B12 Levels on Metformin Patients

Patients who use metformin might experience reduced levels of Vitamin B12.  Older patients in particularly can have a decrease in cognitive performance, according to study results published in The Journal of Endocrinology & Metabolism.

Long-term metformin use has been associated with B12 vitamin deficiency. The goal of the study was to investigate the effects of hyperglycemia and metformin use on folate-related B vitamin biomarkers and cognitive performance in older adults.  Researchers assessed 4160 community-dwelling older people (average age, 74.1 years) for biomarkers of folate, vitamin B12, vitamin B6, and riboflavin.

Classified as normoglycemic (n = 1856) or hyperglycemic with (n = 318) or without (n = 1986) metformin treatment, each participant was assessed for cognitive ability according to the Repeatable Battery for Assessment of Neuropsychological Status and the Frontal Assessment Battery.

On average, patients with hyperglycemia were older, more overweight, and had worse renal function than patients who were normoglycemic. All groups demonstrated normal mean scores on all cognitive tests.

Compared with patients with normoglycemia and patients with hyperglycemia not treated with metformin, patients with hyperglycemia who received metformin treatment were at greater risk for deficiency in vitamin B12 (combined B12 index ≤-1; odds ratio, 1.45) and B6 levels (plasma pyridoxal 5-phosphate <30 nmol/L; odds ratio, 1.48).

After adjusting for various confounding factors, results from the Repeatable Battery for Assessment of Neuropsychological Status and Frontal Assessment Battery tests demonstrated that metformin use was associated with elevated risk for cognitive dysfunction (1.36 and 1.34, respectively).

Because of the cross-sectional nature of this study, the researchers noted an inability to confirm causal relationships between diabetes/metformin use and B-vitamin deficiency.

From the ADA 2019 guidelines, “A recent randomized trial confirmed previous observations that metformin use is associated with vitamin B12 deficiency and worsening of symptoms of neuropathy (43). This is compatible with a recent report from the Diabetes Prevention Program Outcomes Study (DPPOS) suggesting periodic testing of vitamin B12 (44)”. The recommendation is to test Vitamin B12 periodically, like once a year to make sure patients have not develop Vitamin B12 deficiencies.

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Metformin

Metformin is a medication for type 2 diabetes, decreases the liver’s glucose output and increases the muscles’ glucose uptake. Metformin remains not only first line therapy but one of the most used medications for Type 2 Diabetes.

Possible side effects: nausea, upset stomach, diarrhea (can sometimes be avoided by taking with food or by using the extended-release formulations).

Should not be taken by persons with decreased kidney function or certain other medical conditions.

Medications available: metformin (Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet).

Metformin is an inexpensive medication considered first-line therapy for treatment of glucose control in individuals with type 2 diabetes. It is also widely used to improve cardiovascular risk in adults with type 2 diabetes.

Reducing with Metformin Vascular Adverse Lesions in Type 1 Diabetes (REMOVAL)

This study examined if similar benefits could be expected for people with type 1 diabetes. Metformin may be prescribed for people with type 1 diabetes who are also overweight, to help control blood sugar and weight, allowing a lower daily insulin dose.

This multi-center, international clinical trial enrolled patients at 23 centers across the United Kingdom, Australia, Canada, Denmark and the Netherlands. Researchers investigated three years of treatment with metformin reduces heart disease in middle-aged adults with type 1 diabetes who are at increased risk for cardiovascular disease (CVD).

REMOVAL studied 428 middle-aged adults with longstanding type 1 diabetes–on average for 33 years. The patients had three or more risk factors for cardiovascular disease, including BMI over 27; A1C greater than 8.0; known CVD/peripheral vascular disease; current smoker; high blood pressure; high cholesterol or triglycerides; strong family history of CVD; or duration of diabetes more than 20 years.

Patients who received metformin lost weight, and their insulin doses were able to be reduced during the study.

However, A1C levels showed reduction only during the first three months of metformin treatment. Cholesterol was also reduced, even though more than 80 percent of trial participants were already taking statins. Weight reduction and lowering of cholesterol may therefore have played a role in reducing atherosclerosis.

The Diabetes Prevention Program Outcomes Study (DPPOS)

Was an extension of the Diabetes Prevention Program (DPP) to determine the longer-term effects of the two interventions, reduction in diabetes development and reduction of development of the diabetes complications. Complications like blindness, kidney failure, amputations and heart disease. Funded largely by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the new findings show that the lifestyle intervention and metformin treatment have beneficial effects, even years later, but did not reduce microvascular complications.

Metformin long term use:

Metformin treatment was associated with a modest degree of long-term weight loss. There is also a small increase in vitamin B-12 deficiency, overall metformin treatment has been extremely safe and well-tolerated.

Metformin Works Better in African Americans

In a study of electronic health records of 19,672 people with type 2 diabetes, starting on metformin led to a 0.90 percentage-point drop in A1C—a measure of blood glucose control for two to three months—in black participants versus just 0.42 in whites. The researchers took factors such as age, sex, body mass index, and starting A1C into account, so the difference more likely has to do with genetics.

Metformin may help fight off brain and nervous system diseases

Those taking metformin for two to four years had a 40 percent lower risk of developing Alzheimer’s disease, Parkinson’s disease, and other brain and nervous system problems, while those taking the medication for longer than four years had an 80 percent lower risk. The brain benefit remained even after the investigators accounted for factors such as age, gender, race, and obesity.

Polycystic ovary syndrome (PCOS)

The cause of PCOS is still unclear, but researchers know one thing for sure: There’s a link between PCOS and diabetes. Women with PCOS are often insulin resistant, a condition that’s an important trigger for type 2 diabetes. The insulin resistance of PCOS is often treated with metformin.

Metformin is a very safe medication, that doesn’t cause low blood sugars, can lead to a modest reduction in weight and the most important, a reduction in cardio vascular risks.