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7 Special Effects of Metformin on Diabetics

There are 7 special effects of metformin that diabetic people often face

At the end of 2019, the American Diabetes Association (ADA) released the Diabetes Diagnosis and Treatment Guidelines 2020, and jointly released the updated version of the Consensus 2019 for Type 2 Diabetes Hyperglycemia Management with the European Diabetes Research Society (EASD). Metformin, as a first-line medication, is recommended if there are no contraindications or intolerance, metformin should be preferred. Prior to this, due to the excellent performance of some new drugs in experimental studies, there was a tendency to replace metformin as the first choice. It now appears that metformin is still the drug of choice.


Crucial Effects of Metformin on Diabetic people

Many doctors and patients have concerns when using metformin, especially after seeing a lot of contraindications listed in the instructions. In fact, in many special cases, metformin can still be used.


1. Senior

If there is no kidney disease, even if there is a physiological decline in renal function in elderly patients, it is safe to take metformin, and the low risk of hypoglycemia is particularly valuable for elderly patients. Older patients only need to monitor kidney function regularly (once every 3 to 6 months), and they need to stop metformin when severe renal insufficiency occurs.


2.  Young age

Many children and adolescents are now suffering from type 2 diabetes. If simple lifestyle interventions are ineffective and blood glucose levels do not need to start insulin therapy, children 10 years of age and older may consider using metformin, which is currently not recommended for children under 10 years of age.


3.  Heart failure

Heart failure can cause tissue hypoxia, and the use of metformin may be a potential risk. In fact, metformin itself does not cause or exacerbate heart failure.

Drug Metformin for Diabetes and Diabetes chart of HbA1c equiv
Adjust Metformin  per the diabetes Risk

On the contrary, it may be related to the reduced risk of heart failure and death in patients with diabetes. Therefore, metformin can be used in patients with stable heart failure, but only for patients with acute and unstable heart failure.


4. Liver disease

Metformin is not metabolized by the liver and has no liver toxicity. Studies have also shown that metformin is beneficial for the treatment of liver diseases, especially in the presence of insulin resistance and inflammation.

However, when the liver function is seriously impaired, the body's ability to clear lactic acid decreases significantly, so it is recommended that patients with serum transaminase exceeding 3 times the upper limit of normal or with severe liver dysfunction should avoid using metformin.


5. Nephropathy

Metformin itself has no damage to the kidneys, and more studies have shown that metformin may have kidney protective effects. However, in order to avoid lactic acidosis, it is recommended that metformin need to be reduced when the renal function is mild-moderately decreased G3a phase, and metformin is disabled when the renal function is moderately-severely decreased (G3b phase) or worse. The ADA guidelines are broader, and it is considered safe to use metformin in the G3b phase.


6. Anemia

Although studies have shown that long-term use of metformin can cause vitamin B12 to decline, there are also studies that have found that metformin can improve vitamin B12 metabolism in cells. Therefore, long-term use of metformin does not require routine supplementation of vitamin B12, vitamin B12 levels can be measured once a year, if lack of replenishment, even anemia patients do not have to refuse metformin for this reason.


7. Gastroenterology

Studies have shown that gastrointestinal reactions caused by metformin mostly appear in the early stage of treatment (the vast majority occur in the first 10 weeks), and most patients can gradually tolerate or disappear as the treatment time prolongs.

Recent domestic studies also found that the incidence of gastrointestinal adverse events did not increase with dose.

Therefore, patients with gastrointestinal diseases can also try to start with small doses and gradually increase the dosage, as well as choose enteric-coated capsules (such as Junlida), sustained release and other dosage forms to reduce gastrointestinal adverse reactions.


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