Metformin and insulin controversy

Patients with type 2 diabetes may not benefit from oral medication as well as insulin

Source: Press release from the British Medical Journal April 18, 2012

“Research: Comparison of metformin and insulin versus insulin alone for type 2 diabetes: systematic review of randomised clinical trials with meta-analyses and trial sequential analyses

Patients suffering from type 2 diabetes may not benefit from taking both an oral glucose lowering drug (metformin) and insulin instead of insulin alone, a study published on claims.

The researchers say the combination leads to better blood sugar control, less weight gain and less need for insulin. However, they also suggest that more trials are needed to provide firm evidence about the long term benefits and harms of the combination and specifically about the risks of premature death.

Metformin, the glucose lowering drug, is currently recommended by guidelines for patients with type 2 diabetes starting on insulin.

The authors of the study, from the Copenhagen Trial Unit, Steno Hospital, and the Copenhagen University Hospital, reviewed 2217 patients in total, all of whom had type 2 diabetes and were over 18 years old.

The reporting of patient important outcomes, such as total mortality and deaths from cardiovascular disase, was very sparse among the included trials.

Twenty trials reported that levels of HbA1c (a measure of average blood sugar levels over time) were reduced with the combined use of the drugs. Body mass index (BMI) and weight gain were also significantly reduced by metformin plus insulin by an average of 1.6 kg.

The authors say that, owing to the risk of severe hypoglycaemic attack increasing with the use of metformin plus insulin, there should be further research on the long term benefits and harms of the combination of the drugs.”

At the Magaziner Center for Wellness, we look at each and every patient’s unique biochemistry by testing blood and urine, as well as identifying any vitamin and nutrient deficiencies and/or food allergies or sensitivities.

In many cases, our first line of defense in helping treat patients with diabetes is a healthy weight loss program. We work with patients to help them achieve their ideal body weight – either through dietary modifications, or, often, through more aggressive approaches that help patients take the weight off more quickly, including medically-based diets that utilize naturally-occurring hormones that stimulate metabolism, suppress appetite and mobilize fat.

Diabetes is an inflammatory process so one of the best approaches to managing the disease is following an anti-inflammatory diet rich in fruits, vegetables, legumes, unrefined and unprocessed grains – plant foods that are rich in fiber, which is beneficial for helping control blood sugar levels. Essentially, we advise our patients to eat foods that are slowly metabolized – often called low glycemic index foods. For example, we have found that certain plant foods like Brewer’s Yeast, broccoli and other related greens, okra, peas, Fenugreek seeds and sage have helped our patients with Type 2 diabetes manage their condition.

Regular exercise is not just recommended – it is crucial – to help insulin work more effectively.

We also use nutriceuticals and herbal and nutritional supplements to assist in metabolism and help combat glucose intolerance. These include chromium, magnesium, zinc and vanadium. In some cases, we will utilize intravenous vitamin infusions to help protect the body from nerve damage – this procedure allows delivery of vital nutrients directly to the bloodstream, rather than having to be routed through the intestines where many may be partially absorbed.

In cases where it is identified that the diabetes has already resulted in inflammatory disease that has affected cardiovascular function, we will often recommend chelation therapy, which involves the intravenous infusions of EDTA (a synthetic amino acid) to help remove heavy metals that may increase the production of free radicals that could further damage the tissues of the heart and perhaps contribute to poorly functioning arteries.