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Metformin: Two for the Price of One?

Primary Care Blog

This week, the competitive shopping event known as Black Friday will descend upon us.  That's the day when retailers beguile us with tempting offers in hopes that we'll buy more while we're there, having valiantly fought off the other shoppers.  Short of being given something for free, BOGO (buy one, get one) is the next best thing.  Just over a week ago, I commented on a study suggesting that statin use lowered the risk of cancer death.  So if you need to take a statin (having failed all lifestyle attempts at lowering one's cholesterol), isn't it nice to know that you might also be lowering your risk of death from cancer?

With that in mind, I thought I'd point out a retrospective cohort study published earlier this month in Annals of Internal Medicine, in which the authors concluded that use of sulfonylureas to lower blood sugar in diabetics was associated with an increase risk of heart disease deaths compared to use of metformin.  I'll be the first to admit that given a choice, I like to use metformin if intense lifestyle modifications aren't enough to deal with one's diabetes, mainly because the biguanide doesn't cause hypoglycemia, which can be a real problem in the elderly.  And now a study suggests this same drug is less likely to cause heart disease death.  Woo hoo!

So go talk to your family doc or endocrinologist and see if metformin is right for you.  And do you really need a sulfonylurea?  Just know that if you have kidney problems, you probably shouldn't be using the biguanide, metformin, as it can cause lactic acidosis.  But aside from that point, it's a very safe & easy to use medication.  And do remember that what you eat and your level of physical activity are paramount in controlling your sugars.

Alvin B. Lin, MD, FAAFP
 
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at 
http://alvinblin.blogspot.com/.