December 20, 2016

Preventing or Delaying Type 2

At least the American Diabetes Association is including information that has been published by others during the year relating to metformin and vitamin B12 deficiency.  

Now I will quote from the statements by the ADA:
  • Metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially for those with BMI greater than or equal to 35 kg/m2, those aged less than 60 years, women with prior gestational diabetes mellitus, and/or those with rising A1C despite lifestyle intervention. A
  • Long-term use of metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy. B

Pharmacologic agents including metformin, α-glucosidase inhibitors, orlistat, glucagon-like peptide 1 (GLP-1) receptor agonists, and thiazolidinediones have each been shown to decrease incident diabetes to various degrees in those with prediabetes. Metformin has the strongest evidence base and demonstrated long-term safety as pharmacologic therapy for diabetes prevention (37). For other drugs, cost, side effects, and durable efficacy require consideration.

Metformin was less effective than lifestyle modification in the DPP and DPPOS but may be cost-saving over a 10-year period (34). It was as effective as lifestyle modification in participants with BMI greater than or equal to 35 kg/m2 but not significantly better than placebo in those over 60 years of age (17). In the DPP, for women with history of GDM, metformin and intensive lifestyle modification led to an equivalent 50% reduction in diabetes risk (38), and both interventions remained highly effective during a 10-year follow-up period (39). Metformin should be recommended as an option for high-risk individuals (e.g., those with a history of GDM, those who are very obese, and/or those with relatively more hyperglycemia) and/or those with rising A1C despite lifestyle intervention. Consider monitoring B12 levels in those taking metformin chronically to check for possible deficiency (see Section 8 “Pharmacologic Approaches to Glycemic Treatment” for more details). Unquote”

This is a very good statement by the ADA and tells us, at least on this topic, that they are at least concerned about vitamin B12 deficiency.

Several of our support group members have contacted me when I sent them an email about this and a link to the 2017 ADA Guidelines. Allen said that Barry, Ben, and he were happy this is in the guidelines and they thanked me for bringing this to their attention. They said they were forwarding my email and link to all of the members. I thanked them for that and said I appreciated them doing this.

Later, Brenda called and thanked me for the information and was thinking of using the guidelines for the topic. I told her I would help where I could and give the person chosen, any links necessary. She thanked me and said she would make the person aware of this.

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