Metformin for people who do not have diabetes?

The CEO of Diabetes in control Read about it and found fascinating like a lot of people. We contacted the members of our advisory committee and asked:

Your patients may have asked questions about this or, if they are not yet, they will probably do so. What is your comment on whether or not to recommend metformin to people without diabetes?? If you do not, how do you respond to patients who ask for it? If you do, what do you say to your patients? And what do you tell your patients when their other health professionals tell them that it is a diabetes medicine and that they should only take it as long as they are safe. do they have diabetes??

Here are the comments we have received so far:

Dr. Stuart Weiss:

As with most drugs, the use of metformin has both positive and negative side effects. I have patients who complain about bad news and those who hear positive news. Recently, the news on metformin has been more positive. From anticancer drugs to effects on telomere length, there are good reasons to consider specialized clinical trials using metformin to answer specific questions. A year ago, it was another story. Who knows where we will be in five years?

Regarding the recommendations for the use of metformin in people without diabetes, too long-term results are unclear whether metformin can be widely used as an anti-cancer drug or a life-enhancing drug. Healthy eating and an active lifestyle promote health.

Sorry, there is no shortcut! (Again)!!!

Dr. Viswanathan Mohan:

The situations in which I recommend metformin in people without diabetes are:

In young women with polycystic ovarian disease and obesity, metformin is a fairly standard routine treatment used by Indian obstetricians, doctors and endocrinologists who believe that it helps to reduce the symptoms of PCOS. It helps to normalize menstrual cycles and also contributes to some extent to weight loss.

The other situation in which I recommend metformin concerns people with prediabetes who also have a family history of diabetes and are therefore at high risk of becoming diabetic. There is no doubt that lifestyle modification, diet, exercise and weight loss are much more powerful, but in some individuals, particularly those with impaired glucose tolerance, metformin works well. Apart from these two situations, I do not use metformin only as a weight reduction tool in people who have normal glucose tolerance.

Unlike Western countries, Indians are not very aware of metformin and they generally tend to avoid taking as many drugs as possible and changing their lifestyle. So we are not often confronted with this problem. However, among the members of the higher socioeconomic groups who are also literate, we can sometimes have these questions. In such situations, we discuss the pros and cons with the patient. As I said earlier, if they have glucose tolerance or impaired PCOS, we usually just use metformin. Otherwise, we do not recommend using the same thing.

As for the prescription of anti-cancer or anti-aging, I would not use it. We will have to wait to have more data, especially in the long run. We all know that metformin is not entirely without side effects. It can have gastrointestinal side effects such as bloating and diarrhea in many people, apart from the very low risk of lactic acidosis.

Dr. Stanley Schwartz:

Our current logic for the pathophysiology of diabetes, its complications and other conditions with overlapping genes and pathophysiologies (see slides) implies that many agents for diabetes can and can be reused to treat related conditions; this logic can probably be applied whether the patient is diabetic or not.

For example, the data is available on the effectiveness of the use of metformin or pioglitazone in the treatment of NASH; similarly, reports suggest the effectiveness of using pioglitazone to treat psoriasis, whether it is diabetic or not.

Similarly, some evidence suggests that dementia is reduced in diabetic patients on metformin, and in vitro and rodent studies suggest possible mechanisms to explain its beneficial effect. No evidence is available in nondiabetic patients, but our construction logic suggests that it is possible.

In addition, biochemical mechanisms are described for the logic of using metformin for the prevention / treatment of cancer. (See attached images, although data is scarce.)

Thus, in an evidence-based PRACTICAL clinical care mode, I occasionally use metformin in the treatment of NASH, whether it is diabetic or not.

In a non-diabetic patient who requires treatment with metformin to avoid cancer or dementia, I would not want to try it, especially if I could clinically discern that there is evidence of existing pathophysiological mechanisms in each patient for each genes or other pathophysiological mechanisms that could be treated with metformin – inflammation, insulin resistance, environmental hazards, excess fuel (obesity) and family history of diabetes and cancer or diabetes and of dementia. Clearly, the patient would be alerted to "not indicated" use, and would not use it if the patient had kidney failure as per current guidelines.

This approach will certainly be easier when we accept the markers (genomic and epigenomic chips, metabolomic chips and proteomics) suggesting that metformin (and other diabetes medications) would benefit. Clearly, our model, at a minimum, suggests areas in which future research could be oriented.

For you, our members, how do you answer these questions? Please send your answers to: [email protected]