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So much more in Metformin | Print Edition – The Sunday Times, Sri … – The Sunday Times Sri Lanka

Some drugs are commonly referred to as “wonder drugs” because of their ability to significantly improve or cure a particular medical condition.  Hailed as major medical advancements, these drugs often have a major impact on public health. Examples of wonder drugs include antibiotics, which have revolutionised the treatment of bacterial infections, and antiretroviral drugs, which […]
Prof4Some drugs are commonly referred to as “wonder drugs” because of their ability to significantly improve or cure a particular medical condition.  Hailed as major medical advancements, these drugs often have a major impact on public health. Examples of wonder drugs include antibiotics, which have revolutionised the treatment of bacterial infections, and antiretroviral drugs, which have improved the prognosis for individuals with HIV/AIDS. These drugs have had a profound impact on the treatment and management of various medical conditions and have improved the quality of life for millions of people worldwide.
Of these, metformin may be the biggest in terms of the profound health benefits it has brought to millions of sufferers from diabetes since its discovery more than half a century ago. Now research is showing us that this cheap and widely available drug has benefits beyond its use as an effective treatment for diabetes.
Type 2 diabetes is a chronic condition that affects millions of people worldwide. It occurs when the body does not use insulin properly, leading to high blood sugar levels. Insulin is a hormone that helps regulate blood sugar levels by allowing cells to use glucose for energy. Left untreated, high blood sugar levels can lead to serious complications including heart disease, nerve damage, kidney damage and vision loss.
Metformin is one of the most commonly used medications to treat type 2 diabetes. A member of the biguanide class of drugs, metformin works by reducing the amount of glucose produced by the liver and increasing the sensitivity of muscle cells to insulin. It is well-tolerated and has a low risk of causing low blood sugar (hypoglycaemia).
In the late 1920s, French researchers observed that the extract of the plant Galega officinalis (commonly known as French lilac or goat’s rue) had anti-diabetic properties. The active ingredient was later identified as guanidine, and several derivatives were synthesised and tested for their potential as anti-diabetic agents. One, called phenformin, was effective at lowering blood sugar levels and was introduced as a treatment for diabetes in the 1950s. However, phenformin was associated with a high risk of a serious side effect called lactic acidosis, and was discontinued from use in the 1970s.
Metformin, another derivative of guanidine, was developed as an alternative to phenformin. Unlike phenformin, metformin does not cause lactic acidosis and has a lower risk of side effects. It was first introduced in France in 1979 and has since become a widely used medication to treat type 2 diabetes. It is well-tolerated and has a low risk of causing low blood sugar (hypoglycaemia). It is also relatively inexpensive and has been available for use for many years, so its safety profile is well-established. It is currently available in generic and brand-name formulations and approved for many countries worldwide.
Besides its use as an antidiabetic medicine, metformin has other health benefits. One of the most promising areas of research on metformin is its potential to prevent or delay the onset of type 2 diabetes. Studies have found that metformin may be effective at preventing the development of type 2 diabetes in individuals with prediabetes, a condition characterised by elevated blood sugar levels that are not high enough to be classified as diabetes. In one study, individuals with prediabetes who took metformin for three years had a 31% lower risk of developing diabetes compared to those who did not take the medication.
Metformin positively affects cardiovascular health. Studies show that it helps lower blood pressure and reduce the risk of heart attack and stroke in individuals with diabetes. Metformin also reduces inflammation, a key factor in the development of cardiovascular disease. In one study, individuals with diabetes who took metformin had lower levels of inflammatory markers in their blood compared to those who did not take it.
It is also a potential weight loss agent, even in those not suffering from diabetes. Metformin may cause weight loss by reducing the amount of glucose produced by the liver and increasing the sensitivity of muscle cells to insulin. By improving insulin sensitivity, metformin lowers blood sugar levels and decreases the number of calories stored as fat. Metformin increases the number of calories burned during exercise, leading to weight loss. Metformin is now advocated as a useful adjunct medicine in patients who are on potentially weight inducing drugs such as antidepressants and antipsychotics.
Metformin is a possible cancer-preventive agent. Research has suggested that metformin reduces the risk of certain types of cancer, particularly breast, colon and prostate cancer. In one study, individuals with diabetes who took metformin had a lower risk of developing breast cancer compared to those who did not take the medication. Another study found that metformin was associated with a reduced risk of colon cancer in individuals with diabetes. However, more research is needed to confirm these findings and to understand the mechanisms by which metformin may protect against cancer.
Some research shows that metformin is an anti-aging drug. A key feature of aging is the decline in insulin sensitivity, which can lead to the development of type 2 diabetes and other age-related diseases. Metformin increases insulin sensitivity, which might delay or prevent the onset of age-related diseases. Besides its effects on insulin sensitivity, metformin also has other potential anti-aging effects. Some research show that metformin activates a group of enzymes called sirtuins, which regulate aging. Activation of sirtuins has increased lifespan in certain research animals, and scientists believe metformin has a similar effect in humans. Metformin also has anti-inflammatory and antioxidant effects, which have a protective effect against age-related diseases.
Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects women of reproductive age and is characterised by irregular periods, excess male hormones, and small cysts on the ovaries. It is a leading cause of infertility and is also associated with an increased risk of other health problems such as type 2 diabetes, cardiovascular disease, and mental health disorders. Metformin, by improving insulin sensitivity and reducing insulin resistance in women with PCOS, helps improve menstrual regularity and reduce androgen levels. It has other useful effects in women with PCOS, including reducing weight and improving cholesterol levels and anti-inflammatory effects.
The most common side effects of metformin include stomach upsets, diarrhoea and nausea, which may be reduced by taking it with food or gradually increasing the dosage. Individuals with certain medical conditions such as kidney disease or a history of lactic acidosis, should not take metformin. This is rare and more likely to occur in the elderly.
Metformin is indeed a wonder drug with the potential benefit in several areas other than treating diabetes. However, it is important to use metformin with a healthy lifestyle, including a balanced diet and regular physical activity. Also note that metformin is a prescription drug. You must always discuss any potential risks and benefits with your doctor before using metformin.
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Print Edition – The Sunday Times, Sri Lanka

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