Metformin, also infamously known as its trade name Glucophage has been clinically used for over 60 years. It is the most common first-line of oral tablets, belonging to the biguanide category of anti-diabetic medication. Apart from benefitting the cardiovascular system, it also has tolerable side effects on the gastrointestinal system. In the latest development, Glucophage is being utilized for female patients with Polycystic Ovarian Syndrome who are met issues of being overweight, an irregular period of menstruation and a high amount of male hormone known as Testosterone.
Glucophage mechanism of action is mainly by reducing the production of glucose through a process known as gluconeogenesis in the liver, increase insulin sensitivity in the muscle cells and reduce glucose absorption by the intestinal wall. Hence, it provides a stable blood sugar level throughout the day including post- mealtime.
Here’s what has been observed over long term usage of Glucophage, by Doctoroncall :
1. Its role in preventing diabetes
- The Diabetes Prevention Program which follows a 15 years long research has reached proven that subjects with higher baseline fasting glucose or HbA1c and women with a history of GDM benefit most from using Metformin. HbA1c test is done every 3 months once to monitor the adequacy of diabetic management and patient’s compliance based on average blood glucose level for the last 3 months.
2. Risk of hypoglycemia
- Diabetic patients are responsible for managing the intricate balance between hypoglycemia from too much insulin or deadly complications from too much blood sugar. However, with Metformin, treatment has not been associated with hypoglycemia unless used in conjunction with other glucose-lowering medicine or not consuming food with the consumption of metformin.
3. Metformin and weight loss
- In this department, the average weight loss with metformin is only 1.1 kg as compared to other types of antidiabetic such as glucagon-like peptide-1 (GLP-1) analogues and sodium-glucose cotransporter 2 (SGLT2) inhibitors, but has better outcome over sulfonylureas, which lead to a weight gain of 2–3 kg. However, this effect is much more effective if patients choose to adopt an active lifestyle at the same time.
4. Protection against cardiovascular system
- Metformin may protect against atherosclerosis in prediabetes and early diabetes mellitus especially among men. This effect is believed to be related to its ability to cause weight loss as one of the complications with being overweight is increased in blood lipid and cholesterol levels. The excess fat substance will then be deposited in blood vessels causing atherosclerosis. Atherosclerosis is the main culprit in a lot of chronic illnesses including diabetes, hypertension as well as liver and kidney disease.
5. Benefits in kidney function
- Kidney problems caused by diabetes is also known as diabetic nephropathy.. Over time the high blood sugar associated with diabetes cases, especially ones which are not well managed can cause high blood pressure. Consequently, the increased pressure in the kidney’s filtration system decreased kidney function and kidney failure.
- However, caution is needed for use of metformin in chronic kidney disease having eGFR less than 30 ml min−1 [1.73 m]−2 with appropriate dose reductions and monitoring of renal function due to fear of lactic acidosis complication.
In conclusion, based on the mentioned long term effect of Glucophage by Doctoroncall, it is generally safe and well tolerated over prolonged usage. Only in a small number of selected individuals who aren’t able to withstand its side effects and/or whose diabetic control aren’t producing satisfying outcome, metformin will be removed and replaced with other groups of diabetic medications. Medical management of diabetic patients is basically a careful trial and error as their body physiology reacts differently, hence requiring personalized and curated cocktail of medications.
Reference
Marshall, S.M. Diabetologia (2017) 60: 1561. https://doi.org/10.1007/s00125-017-4343-y
- (2012). Long-Term Safety, Tolerability, and Weight Loss Associated With Metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care, 35(4), 731–737. doi: 10.2337/dc11-1299
- Goldberg, R. B., Aroda, V. R., Bluemke, D. A., Barrett-Connor, E., Budoff, M., Crandall, J. P., … Temprosa, M. (2017). Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium. Circulation, 136(1), 52–64. doi: 10.1161/circulationaha.116.025483
- Lian Tock, Ana R. Dâmaso, Aline de Piano, et al., “Long-Term Effects of Metformin and Lifestyle Modification on Nonalcoholic Fatty Liver Disease Obese Adolescents,” Journal of Obesity, vol. 2010, Article ID 831901, 6 pages, 2010. https://doi.org/10.1155/2010/831901.
