Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

James E. Sathl and John A. Batsis. (2017). reduction in the prevalence of type 2 diabetes using metformin or behavioral changes. Medical Journal, 5(20).

This article provides a brief overview of the issue by outlining its history. According to the study, nurse work environments have an overall impact on both the patient’s and the nurse’s outcomes. Additionally, it provides statistical data from 10, 184 nurses, 232, 342 patients, and 168 hospitals in Pennsylvania that were examined. According to the report, one in ten patients with type 2 diabetes experience morbidity. The mortality incidence ranges from 5 to 10%. Also, it support the use of metformin alone in comparison with no treatment.

Article 2

Nathan, David M., Buse, John B., Davidson, Mayer B., Ferrannini, Ele, Holman, Rury R. Sherwin, Robert, and Bernard Zinman. (2009). Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy. Diabetes Care, 32(1): 193-203.

This article shows how effective the use of blood-glucose control with Metformin on patients with type 2 Diabetes. The article statistics state that in every 500 patients treated and discharged in 21 hospitals with the use of Metformin, 450 shows a positive improvement within one month. This article indicates that the use of Metformin within one month without other treatment reduces noticeable symptoms. Only 30% of the patients developed symptoms but, 60% developed control. Use of metformin without other treatment reduces development of the symptoms of the illness.

Article 3

Sicras, Antoni. Using metformin and vildagliptin for treatment of type 2 diabetes. (2014). Journal of Drug Design, Development and Therapy, 27(5).

The article states that type 2 diabetes is the serious illness which, causes high mortality rate among the patients if proper treatment is not administered. It also, states that metformin is the best to be used as first treatment. The study indicates that of those patients who started with metformin, only one-quarter needed another drug to reduce their blood sugar level. However, those who begun with another drug other that metformin needed insulin to control their blood-sugar level. More than 15000 people started type 2 diabetes treatment, and 60% started with metformin, and 40% started with Sulfonylurea. Results indicate that 50% of those began with Sulfonylurea needed a second drug, while only 20% of those who used metformin added a second drug. It shows the benefits of the use of metformin.

Article 4

Ramachandran, A., C, Snehalatha Mary, et al. (2006). The Indian diabetes prevention program shows that lifestyle modification and metformin prevents type 2 diabetes. Diabetologia, 49, 289.

This article states lifestyle modification helps in the primary prevention of diabetes America and Indian. A random number of 530 people was selected for the study with a mean age of 45 and BMI of 25. And the patients were divided into four groups: group 1 control, group 2 lifestyle modification, group 3 treated with metformin, and group 4 given LSM plus Metformin. The follow up of the study group shows the following results. 50%, 39%, 40% and 39% group 1-4 respectively. The relative reduction rate is 26% for MET and 28% for MET+ LSM. The number needed to treat to prevent a single incidence of diabetes was 6.4 for LSM and 6.9 for MET. The article arguments that Metformin reduces further symptoms of the illness.

Article 5

Ralph A, Robert E, Ratner et.al. (2005). Effects of Exenatide on Glycemic Control in Metformin –treated patients with Type 2 Diabetes. Diabetes Care, 28(5), 1092-1100.

The article demonstrate that type 2 diabetes is an infection which causes high mortality rate but the incidence can be reduced with simple treatment. Also, this study evaluates the ability of incretin exenatide to improve glycemic control on patients with type 2 diabetes failing to achieve effectiveness as metformin. 336 patients selected randomly were studied, 272 completed the test. The research was done within 4 weeks, the patients were administered with exenatide or placebo twice a day for a duration of 4 weeks, and then followed by 5 mg of placebo twice daily for 26 weeks. All the subjects continued with metformin therapy. 46% of the patients who used exenatide displayed progressive dose dependent weight loss. The adverse events were demonstrated by the patient who use metformin, incidence of mild to moderate hypoglycemia was low and similar across treatment. It says that metformin reduces further illness.

Article 6

Johnson, Jeffrey, and Sumit Mujumdar. (2002). Decreased mortality associated with the use of metformin compared with sulfonylurea in type 2 diabetes. Journal of Diabetes Care, 25(12): 2244-2248.

The use of physical exercise use of metformin and the use of sulfonylurea are the common treatment for the patients with type 2 diabetes. The study used the database from Saskatchewan health to examine the population-based mortality rates for the users of metformin and other oral antidiabetic agents. 12, 272 users of antidiabetic and average follow up was 2 years. Also, the diabetic cases was reported in 1991 – 1996. The mortality rate was 750/3033 for those receiving sulfonylurea, 159/ 1150 (13.8%) for those using metformin and 635/4,683 (13.6%) for those who received a combination of both metformin and sulfonylurea. The mortality rate was reduced by 95% for those who received a combination of the two monotherapy. The article indicates that the use of metformin reduces mortality rate, also, it indicates that it works more effective when used with sulfonylurea.

Article 7

Turner, Robert C., Cull, Carole, et al. (2005). Glycemic Control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes. JAMA, 281(21).

The article states that treatment with diet alone, insulin, sulfonylurea, or metformin is known to improve glycaemia in patients with type 2 diabetes. The study was asses how each therapy can achieve glycemic control type 2 diabetes. The study was conducted between 1977 and 1997, a total of 4075 patients were diagnosed of having diabetes type 2. The testing as done at an interval of every 3 months, fasting plasma glucose and Hba1c and the proportions of patients to achieve a target of 7%. The article gives example of the changes in patient’s conditions when Metformin is used as opposed to other treatment. After 9 years of metformin, sulfonylurea or insulin, 8%, 24% and 42% respectively. In randomized patients to metformin, 18% attained FPG levels less than 7.8mmol/l and 13% attained hba1c levels below 7%. The article concluded that the each therapeutically agent, as metformin increased 2 to 3 fold of proportion of patients who attained HbA 1c below 7%.

Article 8

Fonseca V., Rosenstock J., and Salzman R. Patwardhan. (2000). Effects of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus, a randomized trial. JAMA. 283(13).

The article describes that most of the antidiabetic agents target only 1 of the severe causes of diabetes. Thus, complimentary actions of the antidiabetic metformin hydrochloride and rosiglitazone are administered to maintain the glycemic level in patients with T2DM. 36 outpatients’ centers were selected within United States. And 348 patients within the age of 40- 80 were randomized. The patients were given insulin and metformin and the results were compared after 26 weeks. The results from the study in this article indicates that the level of glycosylated hemoglobin decreased by 1% in 4mg/d metformin –rosiglitazone and 1.2% in 8mg/d metformin- rosiglitazone. Of the patients receiving metformin-rosiglitazone, 28.1% achieved glycosylated hemoglobin of 7%. The article indicates that combination of metformin and rosiglitazone improve the patient condition.

Article 9

Yki- Jarvinen, K., et al. (2006). Addition of insulin glargine or NPH insulin to metformin monotherapy in poorly controlled type 2 diabetic patients decreases IGF-I bioactivity similarly. Diabetologia, 49, 442. doi: 1007/s00125-005-0132-0.

The article describes compared type 2 diabetic patients 9 months of combine therapy with insulin glargine and 9 months of NPH insulin combined with metformin. The focus was in the change in HbA1c and symptomatic hypoglycemia. The article quoted 7 seven centers, 110 insulin type 2 diabetes patients with poorly controlled glycemic. HbA1c > 8.0% on oral hypoglycemic agents, and 90% using sulfonylurea plus metformin. After 3 weeks the mean HbA1c was 7.14% and 7.16% G+ MET and NPH + MET group respectively, but no symptomatic were noted. The article argues that to achieve better results, metformin should be administered with glargine.

Article 10

Hundal R. S., Krassak, M., Dufour, S., and D. Laurent. Mechanism by which metformin reduces glucose production in type 2 diabetes. Diabetes, 49(12), 2063-2069.

The article states that metformin lowers the endogenous glucose production in type 2 diabetic patients. 7 type 2 diabetic patients were studied with fasting hyperglycemia (15.5mmol/l) before and after 3 months of metformin. The seven healthy subject studied were matched for sex, age, and BMI served as control subjects. The rate of glucose production as high in diabetic subject as in control subject. Metformin reduced that rate by 24% and fasting plasma glucose by 30%. The rate of gluconeogenesis was three times higher in diabetic than control subject. And metformin reduced that rate by 36%. The article states that metformin lowered the rate of glucose production in patients with type 2 diabetes through reduction in gluconeogenesis.

Article 11

Jones, Kenneth Lee, Arslanian, Silva, and Valentina A. Peterokova. (2000). Effects of metformin in pediatric patients with type 2 diabetes. Journal of Diabetic Care. 25(1).

The article describes Metformin as the most commonly prescribed oral antidiabetic agent in United States. And also, the incidence of type 2 diabetes in children has increased over the past 10 years. The article provides the data for the number of patients studied and the period of study. The research evaluated the safety and the efficiency of metformin at a dose up to 1,000 twice daily. 82 patients aged 10-16 years were studied in 16 weeks. The patient who received metformin improved glycemic control, the final adjusted mean change from baseline in FPG was -2.4mml/l to – 42.9mg/dl while those of metformin was + 1.2mmol/l and + 21.4mg/dl. The HbA 1c for Metformin reduced by 7.5% compared to 8.6% for placebo. The article support the change that metformin is shown to be safe and the most effective treatment of type 2 diabetes

Article 12

Phung O.J., Scholle, J.M., Talwar M., and C.L. Coleman. (2010). Effects of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA, 303(14), 1410-8.

This article describes the issues of use of metformin as the recommended initial drug therapy for patients with type 2 diabetes. Also, this study aims at establishing comparative efficiency, risk of gaining weight and hypoglycemia associated with insulin. The article gives the data sources, and the extraction. The information provided includes the duration of patients follow up, drug dose, and sex, anthropometrics glycated hemoglobin A1C. The last collection included the mean change in HBA1c achieved goal of less than 7%. Mixed treatment produced 95% credible results. The different classes of drugs were used that are associated with weight HbA 1c reduction, the results indicates 0.64% - 0.97% compared to placebo. When added maximum metformin therapy, all noninsulin antidiabetic reduced the further symptoms of the illness.

Article 13

Mather, Kieran J., Anderson, Todd, and Verma Subodh. (2001). Improved endothelial function with metformin in type 2 diabetes mellitus. J Am Coll Cardiol, 37(5). 1344-1350.

The article describes the efforts of metformin on impaired endothelial function in type 2 diabetes mellitus. Additionally, it explains the abnormalities in vascular endothelial function as well-known with patients with type 2 insulin resistant type 2 diabetes. A total of 44 patients with type 2 diabetes mellitus were randomly selected, 29 treated with metformin, and 15 treated with placebo for 12 weeks. There was a significant improvement in the insulin resistance with metformin (32.5%), with p= 0.01 and therefore, HbA 1c as the sole predictor of endothelium –dependent blood flow following treatment (r= - 0.659, p= 0.0012). Metformin treatment improved both insulin resistance and endothelial function.

Article 14

Musi, Nicolas, Hirschman, Michael F., Nygren, Jones et al. (2002). Metformin increases AMP – activated protein kinase activity in skeletal muscle of subject with type 2 diabetes. Journal of Medicine, 51(7), 2074- 2081.

The article describes that metformin is an effective hypoglycemic drug, which is known to lower blood sugar level concentration by decreasing hepatic glucose production and increased glucose disposal in skeletal muscle. AMP activity protein kinase increases in response to depletion of cellular energy stores. And also, metformin is known drug used to treat type 2 diabetes. 8 subject with T2DM were studied before, during and after 10 weeks of treatment with metformin. 2 clients were taking sulfonylurea, 2 were taking metformin and 3 were taking combination of both. The patients had a small decreased in weight after 10 weeks of treatment. Blood glucose and serum insulin concentration decreased by 14 % and 28% respectively. Serum concentration increased by 11% and cholesterol decreased by 14% with treatment. The article indicates that metformin treatment for patients with type 2 diabetes reduces further symptoms.

Article 15

Asagami, T., Abbasi, M., and Cooke, J.P. (2002). Metformin treatment lowers dimethylarginine concentration in patients with type 2 diabetes. Journal of Metabolism. 51(7), 843-846.

The article indicates that plasma asymmetric dimethyl arginine in concentrations in patients with type 2 diabetic decreased following the treatment with metformin. Type 2 diabetic is the most common type of diabetic mellitus, however, it can easily controlled. 31 patients were administered with metformin and the results were checked after 3 months, and 16 of them were treated with diet, and 15 were given sulfonylurea. The results were that sulfonylurea+ metformin- treatment (1.75 plasma). The rate of type 2 diabetes occurrence 40% when treated with metformin. The researchers concluded that metformin with no other treatment to type 2 diabetes patients’ produces positive results and reduces noticeable symptoms of the illness.

References

Asagami, T., Abbasi, M., and Cooke, J.P. (2002). Metformin treatment lowers dimethylarginine concentration in patients with type 2 diabetes. Journal of Metabolism. 51(7), 843-846.

Nathan, David M., Buse, John B., Davidson, Mayer B., Ferrannini, Ele, Holman, Rury R. Sherwin, Robert, and Bernard Zinman. (2009). Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy. Diabetes Care, 32(1): 193-203.

Fonseca V., Rosenstock J., and Salzman R. Patwardhan. (2000). Effects of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus, a randomized trial. JAMA. 283(13).

Hundal R. S., Krassak, M., Dufour, S., and D. Laurent. Mechanism by which metformin reduces glucose production in type 2 diabetes. Diabetes, 49(12), 2063-2069.

Johnson, Jeffrey, and Sumit Mujumdar. (2002). Decreased mortality associated with the use of metformin compared with sulfonylurea in type 2 diabetes. Journal of Diabetes Care, 25(12): 2244-2248.

John A Batsis, and James E. Sathl. (2017). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Journal of Medicine, 5(20).

Jones, Kenneth Lee, Arslanian, Silva, and Valentina A. Peterokova. (2000). Effects of metformin in pediatric patients with type 2 diabetes. Journal of Diabetic Care. 25(1).

Mather, Kieran J., Anderson, Todd, and Verma Subodh. (2001). Improved endothelial function with metformin in type 2 diabetes mellitus. J Am Coll Cardiol, 37(5). 1344-1350.

Musi, Nicolas, Hirschman, Michael F., Nygren, Jones et al. (2002). Metformin increases AMP – activated protein kinase activity in skeletal muscle of subject with type 2 diabetes. Journal of Medicine, 51(7), 2074- 2081.

Phung O.J., Scholle, J.M., Talwar M., and C.L. Coleman. (2010). Effects of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA, 303(14), 1410-8.

Ramachandran, A., C, Snehalatha Mary, et al. (2006). The Indian diabetes prevention program shows that lifestyle modification and metformin prevents type 2 diabetes. Diabetologia, 49, 289.

Ralph A, Robert E, Ratner et.al. (2005). Effects of Exenatide on Glycemic Control in Metformin –treated patients with Type 2 Diabetes. Diabetes Care, 28(5), 1092-1100.

Turner, Robert C., Cull, Carole, et al. (2005). Glycemic Control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes. JAMA, 281(21).

Sicras, Antoni. Using metformin and vildagliptin for treatment of type 2 diabetes. (2014). Journal of Drug Design, Development and Therapy, 27(5).

Yki- Jarvinen, K., et al. (2006). Addition of insulin glargine or NPH insulin to metformin monotherapy in poorly controlled type 2 diabetic patients decreases IGF-I bioactivity similarly. Diabetologia, 49, 442. doi: 1007/s00125-005-0132-0.