Baseline patients' characteristics are shown in Table 1. Relevant to this study, the mean serum creatinine SD was However, the mean eGFR declined significantly from The mean HbA1c was 8. There were 19 patients whose HbA1c change was less than 0. Compared to the improved glycaemia group, worsened glycaemia group had a significantly longer duration of diabetes but lower mean HbA1c at baseline.
Majority of the patients in both groups were on insulin therapy. There was no significant difference between groups in the use of oral antidiabetic agents at baseline. The eGFR remained stable in the group with worsened glycaemia but further declined significantly in the group with improved glycaemia.
Values are in mean SD unless stated otherwise. Figures 2 a and 2 b show the changes in the diabetes treatment regime following metformin discontinuation. Upon discontinuation of metformin, the majority of the patients in the improved and worsened glycaemia group had their medication uptitrated or add-on another medication in particular DPP-IV inhibitor. All patients were on insulin therapy.
We reported the changes in the glycaemia level and glycaemia management among diabetic patients in whom metformin was discontinued due to declining renal function.
While there is a clear recommendation on metformin discontinuation when renal function declines, there is no recommendation on how to manage the glycaemia upon metformin discontinuation. We found that there was no significant change in the glycaemic control at 6-month follow-up after metformin discontinuation. Majority of the patients had their medication uptitrated or had an additional antidiabetic agent when metformin was discontinued.
Although we did not find a significant change in the glycaemic control 6 months after metformin discontinuation, we observed that the glycaemic control deteriorated in the first 3 months after metformin discontinuation.
Interestingly, we found that there were two groups of patients that experienced worsening or improvement in the glycaemic control at 6-month follow-up. The worsening of glycaemia was expected after metformin discontinuation, but optimisation of antidiabetic agents at metformin discontinuation and 3 months of follow-up did not stem off the worsening of glycaemia at 6-month follow-up in the group with worsened glycaemia.
Similar treatment optimisation was observed in the group with improved glycaemia, and in fact, the treatment regimen was downtitrated at 3-month follow-up. A further decline in the renal function in the improved glycaemia group likely contributes to the improvement in glycaemia and explains the downtitration of treatment regimen at 3-month follow-up.
Glucose homoeostasis is complex in diabetic nephropathy. Insulin resistance plays a key role in the worsening of glycaemic control in patients with a decline renal function [ 7 — 9 ]. The increased insulin resistance is the effect of accumulated uremic toxins and increased oxidative stress [ 10 ].
Among the many antiglycaemic actions of metformin is an improvement in insulin sensitivity directly by increasing insulin tyrosine kinase receptor activity and indirectly by reducing lipotoxicity [ 11 ]. Thus, discontinuation of metformin in diabetic individuals will result in greater insulin resistance and worsening glycaemic control. Beside metformin and PPAR-gamma agonist, there is no other antidiabetic agent that would address the pathophysiologic insulin resistance.
Thus, increasing the dose of insulin or sulphonylurea or the addition of a DPP-IV inhibitor might not be so effective in controlling glycaemia after metformin discontinuation.
This was evident in the group with worsening glycaemia after metformin discontinuation in this study. However, consistent with the current opinion, improvement in the glycaemia in patients with diabetic kidney disease might suggest a further decline in renal function, and this is observed in our study. The decrease in the renal capacity of gluconeogenesis reduced clearance of antidiabetic agents, and poor nutrition might contribute to the improvement in glycaemic control or recurrent hypoglycaemia in patients with declining renal function [ 12 — 15 ].
Importantly, the optimisation of antidiabetic treatment must take into consideration the risk of hypoglycaemia. Aside from poor renal function, other risk factors for hypoglycaemia were seen in these patients such as old age, long duration of diabetes, high glycosylated haemoglobin, and the use of insulin. In the group with improved glycaemia, there was less treatment intensification at 3 months of follow-up, and this might have mitigated the hypoglycaemia risk in this group.
That's because the makers of the drugs haven't put it forward for the research. That means metformin isn't labelled as safe to use for weight loss. And although some people think that it makes you gain weight, putting on weight isn't a side-effect of metformin.
While metformin is a drug that is used to treat diabetes, it can also be prescribed for other uses. That's because it can lower insulin and blood sugar levels. This helps women with PCOS with their ovulation and periods. It also lowers the risk of a miscarriage. Speak to your doctor if you want to know more about PCOS and metformin.
If you have type 1 diabetes then you might also start metformin, but only if you have insulin resistance. Metformin can also have other long-term health benefits. These include lowering cholesterol levels and reducing heart disease risk. There is also research taking place into what else metformin can be used for.
This includes as a drug to prevent cancer. But these studies have not found any evidence yet. A company limited by guarantee registered in England and Wales with no. Skip to main navigation Skip to content. Breadcrumb Home guide to diabetes managing your diabetes treating your diabetes tablets and medication metformin. Save for later Page saved! You can go back to this later in your Diabetes and Me Close.
Metformin and diabetes. Metformin is a medication that helps the insulin you produce work better. You usually take it as a tablet. Getting started The first time you get your metformin prescription there will be a lot going through your mind. What does metformin do? When it comes to treating your diabetes, metformin will work by: reducing the amount of glucose sugar the liver releases into the body helping the body's insulin work better.
Different types of metformin When you get your prescription you might notice that it has a different name. Metformin is the most common treatment for type 2 diabetes Your prescription Your metformin prescription can be slow or standard release tablets.
Standard-release tablets Standard-release tablets will give your body medicine quickly. Slow-release tablets Slow-release tablets dissolve slowly. Metformin side effects Like all medicines, metformin has side effects for some people. The second is to implement some healthy lifestyle changes. They will be able to assess the risks and help you get where you want to be.
Here's what might put you at risk. Since a diabetes diagnosis doesn't come with an easy-to-read user manual, we put together this step-by-step guide to performing an insulin injection.
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But, there are rules and limitations. Is it safe to drink alcohol while taking metformin? Here's what you need to know. Okra is a food gaining popularity because of it's impressive nutrition profile. But is it safe to eat with diabetes? Learn the benefits, risks, and…. Oatmeal is a low glycemic food that has many health benefits, especially if you have diabetes.
However, it can cause side effects, and some people may want to look at other options. As a result, levels of glucose, or sugar, in the blood rise too high. Metformin is an oral medication that helps manage the effects of type 2 diabetes.
In people with prediabetes, the drug can also help prevent or delay the onset of the condition. Doctors prescribe metformin to nearly million people worldwide. In this article, we look at the side effects of metformin and why a person with type 2 diabetes might want to stop taking it.
We also look at the risk of not taking metformin and some alternative options. Metformin is an effective treatment for type 2 diabetes. It helps lower blood glucose levels by:. However, metformin has a number of potential side effects. Some are common, while others are rare. A person should talk to a doctor before stopping metformin treatment. Taking the medication with food reduces the risk of digestive problems. Around 30 percent of people taking metformin in the long term experience vitamin B deficiency.
Symptoms can include:. Is it safe to eat grapefruit while taking metformin? Find out more here. In some people, metformin causes blood glucose levels to drop too low, and the medical term for this is hypoglycemia. There is also a very low risk of developing a condition called lactic acidosis, which results from a buildup of lactic acid. This condition can be life-threatening. Certain people taking metformin may also have a risk of kidney damage. A study suggests that metformin may reduce kidney function in people with both chronic kidney disease and type 2 diabetes.
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