Is it right to delay supportive  medication  – insulin sensitizers like metformin / galega – while overweight progresses inexorably to obesity, type 2 diabetes or even vascular death before diabetes can present?

  Metformin is  the only 80-year proven safe drug that has been tested  in a 20year RCT and proven to reduce both overweight by close to 8% longterm, and reduce the incidence of new diabetes by about 50%, and almost halve deaths in diabetics.

Purists argue that this must first be proven in the appropriate RCT. But who is going to pay for another UKPDS, testing metformin against wannabe supplanters like the still-patented but  risky acarbose, sibutramine, orlistat etc?
And how many more billions of overweight people must in the meantime progress to diabetes, disability or earlier death while theoreticians argue, when metformin titrated to tolerance  has been proven to delay  so much disease and death without any serious adverse effect
 At their July 2008 congress  The American College of Endocrinology last week decided:


·         that diabetes now affects about 8%  and  prediabetes 20% of Americans;

·         Diabetes and its complications costs America  almost $200 billion a year;

·         Prediabetes  increases the risk of diabetes 5 fold; and heart disease by 50%;

·         Diabetes complications begin early in the progression from normal to frank diabetes.

·         Conversion of impaired fasting glucose to diabetes doubles CVD,

·         Persons with pre-diabetes should reduce and maintain  weight 5-10% lower- This lowers         

                  hypertension,   glucose, fats and thus all risks;

·         Better lifestyle is difficult to    maintain.

·         Monitoring of patients with pre-diabetes should include testing for . FPG, HBA1C, lipids and

          microalbuminuria at least twice a year.

·         metformin delayed onset of diabetes by 3.4 years and reduced incidence of diabetes by 8% after  

                   30 years.

·         identify people with prediabetes and treat them by recommending changes to lifestyle- diet and

                exercise-  and prescribing drugs if necessary. Otherwise the human and financial cost would 

                be huge, they warned.”

 DIABETES RISKS: In the King’s College London 2008 study in 48 000 diabetics , mortality  was down from 4.3% in 1996 to  2.6%pa by 2005, ascribed to a combination of statins, antihypertensives and metformin.     Their 2005 study showed that even 5 years before diagnosis of diabetes, the future diabetics consulted and were treated far more than controls.

Similarly, in the Munster 2000 prospective  study,  men who went  on to develop diabetes  differed significantly from those who would not  by body mass index, fasting serum levels of glucose and HDL, and family history of  diabetes mellitus.

 The 2005 Scottish analysis  of diabetic studies  over 60  yrs worldwide showed that diabetes increased mortality about 40%, but less in those over 70yrs. The 2006 Univ Surrey GP practice analysis  of 44 000 diabetics  (compared with 220 000 controls)  showed that diabetes almost  doubled mortality. Bandolier reviews Martin et al Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: Diabetalogia 2006 in Germany-  Mortality  rate was 0.57%pa  over 6.5yrs ie by 68.5yrs, in  3,000 diabetes patients from 192 randomly selected practices at time of diagnosis (1995-1999) over 45 years of age, average BMI  30 kg/m 2, a fasting blood glucose of 9.3 mmol/L, and HbA 1c of 7.7%;  after diagnosis of type 2 diabetes, over half of patients had no specific therapy. 

 In the 20year UKPDS  in some 5000 UK  diabetes  patients starting at a mean age of 53ys (25-65yrs),  all mortality on lifestyle-diet  management only  was 28% after 15years ie almost 2%pa by age 68yrs; metformin reduced this by a third.

DIABETES & STROKE: The 1984 Copenhagen Stroke study  found that 20% of strokes were associated with diabetes, such patients were 3 years younger than non-diabetics, half had hypertension, more (24%) died- diabetes almost doubled risk of dying-  and most involved thrombosis rather than bleeding.

  the 2001 Newcastle UK Diabetes study    showed that diabetes increased all mortality almost 4fold compared to non-diabetics.

  And it is common cause that diabetes is the commonest  cause of  devastating neuropathy, amputation  and endstage kidney failure, and overweight let alone diabetes is  the commonest associate of hypertension and lipidemia.

A 1984 study showed that almost 5% of diabetics had visual impairment.

 DIABETES: & CANCER:1994  Italian study shows that, even correcting for obesity,  diabetes increases  the risk of cancer 2 to 3 fold  in liver, pancreas and endometrium Diabetes is associated with 24% increased risk of breast cancer in the 2007  Karolinska worldwide meta analysis,   but not in white women in the US southwest 2008 study  . Only obesity, not diabetes, increased the risk of hghgrade prostate cancer in the USA 2006  study  A history of overweight with hypertension was associated with 77% increased risk of breast cancer  in a 2006 study .          In nondiabetics with breast cancer, raised  fasting insulin doubled the risk of breast cancer in a 2002 study .

 DIABETES & DEMENTIA:  The 1996  Rotterdam Study    showed that 22%  of dementia patients had diabetes, with diabetes increasing dementia risk by 30%, and insulin use trebling the risk of dementia. Recent 2006 studies    suggest that diabetes may increase risk of dementia up to 4fold.


 PREDIABETES: In the 3 to 4yrs Diabetes Prevention Programs in China, USA  and India, moderate dose metformin (ie not metformin adjusted to tolerance)  reduced new diabetes by 30 to 70%. The intensive diet and exercise group in the USA DPP did much better- but they were not patients in real life, they were rare volunteers prepared to commit  as they did for years to strict diet and at least 3.5hours of sweaty exercise a week.

 In the Texas 1995 autopsy study  in accident victims as young as 25years, (as in GIs killed in the Vietnam war)   disease  markers (raised HBA1C, adiposity)  were strongly associated with vascular disease. 

 Thus, given the increasing pandemic of overweight- related diseases from teens upwards, the above studies make it criminal neglect  not to monitor body mass index and waist girth, and enforce permanent  optimal lifestyle, diet and metformin prevention from youth. This onus, as with strong support against smoking and alcoholism, rests as much on every parent and individual as it does on teachers, educational institutions, employers, health insurers and  health workers.

But of course the onus is especially binding on registered professionals- teachers and health workers -and  the of-necessity regulated health insurance/ medical aid providers.

  See the HRT  and supplement papers  above and below , and the recommended condition-specific supplement product information.. For specialist  internist consultation on appropriate supplements including HRT for individual circumstances, email your concise health details to






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