This column (see below) has repeatedly pointed out that metformin (aet 1922), a plant derivative, is the only designer drug ever that has both been tested in a real longterm RCT – 20yrs (the UKPDS 1998)- and shown to halve both all-cause mortality in type 2 diabetics, and the incidence of new diabetics when used preventatively in those at risk at all ages with increasing body fat.
This has now been confirmed by a new analysis by Sally Salpeter’s prolific group – whose 2006 metanalysis showed almost as good results for appropriate HRT. Metformin is simply a variant of appropriate HRT, since metformin, like fish oil, and appropriate testosterone and estradiol replacement, is effectively a prohormone that reduces insulin resistance and thus allows insulin to work and glucose to be metabolised as energy by muscle (including the heart) and brain, instead of being accumulated as fat (triglyceride) everywhere.
But while metformin is the only ‘synthetic’ panacea ever invented that remotely matches fish oil, appropriate HRT and all the other natural therapeutic food micronutrients in combination, it should not be forgotten that there are scores of natural insulin sensitizers listed on the internet; of which the freely available two dozen are easily combined into a potent lowcost combination that, with simple avoidance of sugar and cooked fats – at least halves all disease.
This makes the prescription metformin largely unnecessary- the combination just has to be used with discretion, and sensible regular meals , exercise and the routine supplements, to avoid causing hypoglcemia.
Am J Med. 2008 Feb;121(2):149-157.e2.
Meta-analysis: Metformin treatment in persons at risk for diabetes mellitus.
Sally Salpeter ea Santa Clara Valley Medical Center, CA USA.
PURPOSE: We performed a meta-analysis of randomized controlled trials to assess the effect of metformin on metabolic parameters and the incidence of new-onset diabetes in persons at risk for diabetes. METHODS: We performed comprehensive English- and non-English-language searches of EMBASE, MEDLINE, and CINAHL databases from 1966 to November of 2006 and scanned selected references. We included randomized trials of at least 8 weeks duration that compared metformin with placebo or no treatment in persons without diabetes and evaluated body mass index, fasting glucose, fasting insulin, calculated insulin resistance, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and the incidence of new-onset diabetes. RESULTS: Pooled results of 31 trials with 4570 participants followed for 8267 patient-years showed that metformin reduced body mass index (-5.3%, 95% confidence interval [CI], -6.7–4.0), fasting glucose (-4.5%, CI, -6.0–3.0), fasting insulin (-14.4%, CI, -19.9–8.9), calculated insulin resistance (-22.6%, CI, -27.3–18.0), triglycerides (-5.3%, CI, -10.5–0.03), and low-density lipoprotein cholesterol (-5.6%, CI, -8.3–3.0%), and increased high-density lipoprotein cholesterol (5.0%, CI, 1.6-8.3) compared with placebo or no treatment. The incidence of new-onset diabetes was reduced by 40% (odds ratio 0.6; CI, 0.5-0.8), with an absolute risk reduction of 6% (CI, 4-8) during a mean trial duration of 1.8 years. CONCLUSION: Metformin treatment in persons at risk for diabetes improves weight, lipid profiles, and insulin resistance, and reduces new-onset diabetes by 40%. The long-term effect on morbidity and mortality should be assessed in future trials.