Discontinuing Metformin for Diabetes: Key Considerations Before Making a Decision
In the management of Type 2 diabetes, maintaining control over blood sugar levels is crucial. One commonly prescribed drug for this purpose is metformin, which helps the body become more sensitive to insulin, slows glucose release from the liver, and reduces absorption in the gut [1]. However, it may cause side effects such as digestive problems, headache, and abdominal discomfort. Taking metformin with food may help reduce these risks [2].
Other medications used to manage Type 2 diabetes include Sulfonylureas, such as Amaryl and Glucotrol XL, which stimulate the pancreas to release more insulin but may cause common side effects like hypoglycemia and weight loss [1]. SGLT2 inhibitors, such as Invokana, Jardiance, and Farxiga, help eliminate excess glucose in the urine, improving blood glucose levels, aiding weight loss, and decreasing blood pressure [3]. However, SGLT2 inhibitors may increase the risk of genital yeast infections in individuals with heart or kidney problems [4].
In cases of kidney problems, a doctor may prescribe SGLT2 inhibitors instead of metformin [5]. Metformin can help prevent or delay the onset of Type 2 diabetes in people with prediabetes [6]. It's important to note that stopping metformin abruptly without another way of managing blood sugar may cause an increase in blood glucose levels [7].
DPP-4 inhibitors, such as Tradjenta and Januvia, help improve A1C scores without causing hypoglycemia by preventing the breakdown of GLP-1 and GIP hormones [8]. GLP-1 and dual GLP-1/GIP receptor agonists, like Trulicity, Byetta, Ozempic, and Mounjaro, not only help regulate glucose levels but also aid weight loss and prevent heart disease [9].
Beyond medication, lifestyle changes play a significant role in managing Type 2 diabetes. Regular exercise, making dietary changes, maintaining a moderate weight, and avoiding alcohol can all contribute to effective management [10].
Uncontrolled Type 2 diabetes can lead to long-term complications, primarily caused by prolonged high blood glucose levels damaging blood vessels and nerves throughout the body. These complications generally develop over 5 to 10 years or more and affect multiple organ systems. Cardiovascular complications, such as heart attack and stroke, are accelerated due to atherosclerosis (plaque buildup in large blood vessels) [11].
Diabetes can also cause damage to small blood vessels in the retina, leading to diabetic retinopathy and potential vision loss or blindness [12]. Up to 40% of people with Type 2 diabetes develop chronic kidney disease (CKD) due to damage to the kidney’s filtering blood vessels, which can progress to end-stage renal disease (ESRD), requiring dialysis or kidney transplant [13].
Diabetic neuropathy, or nerve damage, is another common complication, causing pain, numbness, tingling, and increasing the risk of foot ulcers, infections, and potential amputations [14]. Diabetes can also harm the skin, teeth, gums, and gastrointestinal system [15].
Proper management of blood glucose, lifestyle changes, and regular medical checkups are critical to reducing the risk or delaying the onset of these complications [16]. Thiazolidinediones (TZDs), such as Avandia and Actos, help insulin work better in muscle and fat and reduce glucose production in the liver, but may increase the risk of heart failure in some people [17].
In conclusion, managing Type 2 diabetes requires a combination of medication and lifestyle changes. Regular communication with a healthcare provider is essential to ensure the most effective and safe management plan.
- Apart from metformin, Sulfonylureas like Amaryl and Glucotrol XL are also used to manage Type 2 diabetes, but they can cause side effects such as hypoglycemia and weight loss.
- SGLT2 inhibitors, such as Invokana, Jardiance, and Farxiga, help eliminate excess glucose in the urine, but they might increase the risk of genital yeast infections in individuals with heart or kidney problems.
- DPP-4 inhibitors, such as Tradjenta and Januvia, prevent the breakdown of GLP-1 and GIP hormones and help improve A1C scores without causing hypoglycemia.
- GLP-1 and dual GLP-1/GIP receptor agonists, like Trulicity, Byetta, Ozempic, and Mounjaro, not only help regulate glucose levels but also aid weight loss and prevent heart disease.
- Beyond medication, lifestyle changes like regular exercise, making dietary changes, maintaining a moderate weight, and avoiding alcohol can all contribute to effective management of Type 2 diabetes.
- Uncontrolled Type 2 diabetes can lead to long-term complications affecting multiple organ systems, such as cardiovascular complications, diabetic retinopathy, chronic kidney disease, diabetic neuropathy, and skin, teeth, gum, and gastrointestinal system damage.
- Proper management of blood glucose, lifestyle changes, and regular medical checkups are critical to reducing the risk or delaying the onset of these complications, and Medicare may cover the cost of therapies and treatments associated with Type 2 diabetes management, including DPP-4 inhibitors, GLP-1 agonists, and nutritional guidance. In addition, CBD is sometimes used for pain and inflammation management in some patients with diabetes and other chronic diseases, while fitness and exercise, mental health support, and a balanced diet are crucial components of a comprehensive diabetes management plan.
