Association of Diabetes Care & Education Specialists

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Facts about Metformin

Oct 04, 2012

I recently attended a really interesting presentation on Metformin.  Of course, I have been familiar with Metformin for many years. However, our speaker, Charles Reasner, MD, shared with us what I guess you would call “The Rest of the Story.” Here are some facts about Metformin.


  • Metformin was described in the scientific literature starting around 1922.  It was first developed as an antiviral medication.  That did not work out so well, but the medication improved the blood sugar of those patients with diabetes. With the onset of insulin, which was touted as the cure for diabetes, Metformin was largely forgotten.
  • From the French lilac, the name is derived from gluco (sugar) and phage (to eat).
  • It was not until the 1950’s that Metformin was studied specifically for its use in diabetes.
  • The UKPDS was one of the largest studies of its time with patients who were followed from 1977-1991.  The benefits of “good” glycemic control were proven as well as a renewed interest in the use of Metformin to lower glucose values while having low cardiovascular risk.
  • Approved by the FDA in 1994, Metformin was brought to market by BMS on March 3, 1995.  (For some reason, it seems like Metformin has been around much longer than that!)
  • Metformin has a low incidence of hypoglycemia.
  • Metformin is the one diabetes drug which will either have no effect on patients’ weights or in some instanceswill help patients lose weight.
  • Metformin is not metabolized in the body so it does not cause harm to any specific organ.
  • Since Metformin is excreted unchanged through the kidneys, it is important that the kidney be functioning normally. The biggest risk of Metformin therapy is lactic acidosis if there are renal problems.
  • Dr. Reasner reiterated several times that Metformin does not cause kidney damage nor does it cause lactic acidosis. The risk of lactic acidosis increases when Metformin builds up due to renal insufficiency. Thus, it is important to monitor kidney function when patients are taking Metformin.
  • In 2008, a study suggested that Metformin appeared to reduce the formation of Alzheimer’s disease.
  • This past summer, scientists were able to establish a connection between the use of the drug and the activation of certain pathways in the brain that encourage new cell growth and improved function. Metformin is now being looked at as a drug to perhaps treat Alzheimer’s disease.
  • In the past few years, there has been “accumulating evidence” of a Metformin-cancer link. A recent Italian study showed a lower incidence of all forms of cancer – often by as much as 50 percent - especially a decrease in breast and prostate cancer.
  • Most recently, a study showed that the risk of pancreatic cancer is 62 percent lower in patients taking Metformin.  This is huge as currently there are few options in the treatment of pancreatic cancer. This would most certainly warrant further investigation.
  • Best of all, it’s very inexpensive costing only pennies a day.


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  1. Nov 28, 2012

    I am giving a class next Tues and have not been able to find healthy eating info that is specific to Asians, in particular to Koreans and Vietnamese. Does anyone have access to or know about basic healthy eating in these languages? It would be most helpful if info could be emailed to me. A handout in their language would be so great. Thanks. Joyce Trudeau RN, BSN, CDE
  2. Nov 21, 2012

    What the effect of hypertensive and dyslipidemia on neurapathy in type 1 and 2 diabetes.
  3. Nov 11, 2012

    Thank you;
  4. Oct 18, 2012

    I see a question on vitamin B12. CLINICAL PHARMACOLOGY REFERENCE Metformin may result in suboptimal vitamin B12 absorption, possibly due to interference with the B12-intrinsic factor complex. The interaction very rarely results in a pernicious anemia that appears reversible with discontinuation of metformin or with cyanocobalamin supplementation. Certain individuals may be predisposed to this type of anemia; a nested case-control study of 465 patients taking metformin (155 with vitamin B12 deficiency and 310 without) demonstrated that dose and duration of metformin use may be associated with an increased odds of vitamin B12 deficiency. Each 1 gram/day increment in dose significantly increased the odds of vitamin B12 deficiency (OR 2.88, 95% CI 2.15—3.87) as did taking metformin for >= 3 years (OR 2.39, 95% CI 1.46—3.91). Regular measurement of hematologic parameters is recommended in all patients on chronic metformin treatment.
  5. Oct 16, 2012

    In my practice, I come across metformin use with my patients, daily. I would not challange the fact it is the top selling oral medication used to help manage DM II. I have a feeling that if it were prescribed correctly, initially, the sales would be even higher. The accredited diabetes educator should be there from the start, evaluating the patient and collaborating back to other health team members about the patients GI symtoms from the drug. Doses could be cut back to 250mg with meals, moved to bedtime, regimen change, ect. Through collaboration with the prescriber the diabetes educator can help the patient obtain better therapeutic outcomes. The chance the for non-compliance is very high with metformin. The patient may stop taking it, or report back to the doctor "I can't tolerate it". The fact is, "It is a very good drug for managing DM II" and "It is the No. 1 selling oral DM medication dispite these compliance issues. Ask your patients what the directions are their Rx bottle and then start a discussion of why they take it, how they really take it, when they take it and if they know how it works. If they simply know how it works they are more likely to be more compliant and continue using this very good drug.
  6. Oct 16, 2012

    Thank you for the information! Very informative!
  7. Oct 09, 2012

    This was enlightening, I am eager to hear more in it's relation to Alzheimers. Thank You
  8. Oct 09, 2012

    I see a question on vitamin B12. See the link for information on B12 and metformin.
  9. Oct 08, 2012

    Thanks for this Barbara. A good review and learned some things I did not know!
  10. Oct 08, 2012

    This is great, and very useful, information. Thanks.
  11. Oct 08, 2012

    Because metformin has so many benefits and the lactic acidosis issue is way overblown, many endoocrinologists are using metformin even with more significant renal impairment. See my post on this for details and references.
  12. Oct 08, 2012

    Thanks so much for sharing this. I think Metformin is a fascinating medication. I have heard, without being able to name any sources, that the first company that produced Metformin went out of business. The drug was a bust! And there was an item recently, maybe in Diabetes in Control newsletter, that scientists are studying how it works; kind of amazing in this day of designer drugs!
  13. Oct 06, 2012

    Barb, thanks for the info. What concerns do we need to have regarding Metformin and Vit B12 deficiencies? Can patients continue to take Metformin and supplement with B12?
  14. Oct 05, 2012

    Very Informative. I actually had a patient today say that her MD was taking her off Metformin "since it was damaging her kidneys.". I shared the accurate information with the patient so she could continue the discussion with her MD. How often we see misinformation given to our patients.
  15. Oct 05, 2012

    Very Informative. I actually had a patient today say that her MD was taking her off Metformin "since it was damaging her kidneys.". I shared the accurate information with the patient so she could continue the discussion with her MD. How often we see misinformation given to our patients.
  16. Oct 05, 2012

    Barbara, Thanks for sharig; that was very interesting, esp the link with cancer and Alzheimer's disease. Sandy Krafsig
  17. Oct 05, 2012

    excellent presentation!
  18. Oct 05, 2012

    Metformin certainly has had an interesting history, and appears to have a very promising future. Thanks for sharing!
  19. Oct 05, 2012

    I am a diabetes educator/manager of an outpatient education center. Our employee insurance covers employee 100% for diabetes education. Does your?
  20. Oct 04, 2012

    Very interesting.

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