GP advice - take medication (unnecessarily?)

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Ref

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Hi

I was recently diagnosed with type 2 which I am managing through diet and exercise. When I saw my GP recently about a different matter he mentioned that the latest medical advice is to start taking medication as soon as diagnosed and said he may be recommending that for me after my next blood test even if this shows I am managing it well. My instinct is not to take medication until necessary so I'm not keen on his approach.

Have any of you heard of this or had similar advice? What are your views? Am I right or wrong to be wary?

Also, when collecting my prescriptions for lancets the pharmacist seemed to suggest that it is inevitable I will need medication - 'its just a matter of time' - is this true?

Andy
 
Yes, when i was diagnosed 18 months ago it was put straight on Metformin.
 
RachelT said:
Yes, when i was diagnosed 18 months ago it was put straight on Metformin.
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If you don't mind me asking, what were your blood levels at diagnosis? My glucose was 7.1 and my HbA1c 6.2 which I was told meant I was borderline diabetic but managing it well. I'm not overweight and exercise regularly. What advantage is there to taking medication now? Is it inevitable?
 
RachelT said:
Yes, when i was diagnosed 18 months ago it was put straight on Metformin.
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Yes but that depends what stage you were at when you were diagnosed. My HBa1c was over 9% when I was diagnosed so there was no possibility of controlling it without medication.

I think the debate is if people who are borderline should start medication straight away. The new wisdom is that if you start metformin at the first signs of diabetes it will save you having to take bigger doses and more drugs later on.

In which case there would be no diabetics at all who control there condition through diet alone.
 
I havent actually heard this before 😱. I was 11.8 when diagnosed on fasting and was put on diet and exercise (Feb10). Three weeks later they did my first Hba1c which was 8 and I was told I will have to go on Metformin but not until my next review. There again I have one of these doctors that refuses strips for testing 🙄 I test anyway and fasting levels are low 6's some times 5 so I am wondering whether I will really need the Metformin :confused:
 
I was put on metformin from the word go. My GP is tighter than a ducks rear end in a rainstorm, and that's water tight, so he wont prescribe unless he has to or someone else tells him to.

I think it varies very much from area to area and GPs budgets.

Speaking personally I think it is better to stay of pills and potions if you don't need them, and for as long as possible, but we also have to be guided by our GPs and our own experiences.
 
Hi Ref,

I suggest you ask your GP what research he/she is refering to because you'd like to have a look at it before you make a decision?
 
Ref said:
Hi

I was recently diagnosed with type 2 which I am managing through diet and exercise. When I saw my GP recently about a different matter he mentioned that the latest medical advice is to start taking medication as soon as diagnosed and said he may be recommending that for me after my next blood test even if this shows I am managing it well. My instinct is not to take medication until necessary so I'm not keen on his approach.

Have any of you heard of this or had similar advice? What are your views? Am I right or wrong to be wary?

Also, when collecting my prescriptions for lancets the pharmacist seemed to suggest that it is inevitable I will need medication - 'its just a matter of time' - is this true?

Andy
Click to expand...

My personal opinion is that if you are managing to keep within recommended levels using diet and exercise then I would continue to do so for as long as possible. My last HbA was 6.1 and I was offered Metformin but said no. I would do as Runner says and ask him what research he is referring to and then make a decision from there. As far as I am concerned there is no such thing as independent research - so who was it commissioned by?

I also don't think it is inevitable that medication will be needed - some people on here have been d/e controlled for years........and I have to say I plan to be d/e for as long as possible!
 
I was told by the nurse drawing the blood for the 3rd blood test that if the results were still high then I would be put on Metformin straight away. She said they used to try and control via diet and exercise but have found that only delays starting the treatment, there is no real benefit to not going on the tabs.

There again, there is diabetes in my family, mum had diabetes and 4 out of 6 of us children now have it. The doc said there was always a 1 in 2 chance I would be diabetic so it is not a question of wrong diet and too little exercise. Actually, my doc stressed it was in no way my fault.

Taking tabs does not bother me. They keep me alive and I enjoy a relatively pain free normal life.
 
Thanks for all the replies - I will ask my GP about the research - and I'll continue with my own.

My feeling is that this is the latest theory, soon to be replaced by the next theory. The next theory may be more suitable for me but not available because of decisions I make now.

Instinct tells me to avoid medication for as long as possible and my GP has another thing coming if he thinks he can just write a prescription and off I toddle.
 
Ref said:
Thanks for all the replies - I will ask my GP about the research - and I'll continue with my own.

My feeling is that this is the latest theory, soon to be replaced by the next theory. The next theory may be more suitable for me but not available because of decisions I make now.

Instinct tells me to avoid medication for as long as possible and my GP has another thing coming if he thinks he can just write a prescription and off I toddle.
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In late 2008 there was a big hoo-ha about T2s being put on metformin right at the start.
The Diabetes Uk Conference in Glasgow ( spring 2009) went big on the issue and suggested that T2s should be given a trial period on D&E only because it is essential for them to understand the absolute necessity for lifestyle and diet changes and not just think "I'm popping the pill and that's all I need to do".
NICE Guidelines also guarantee an initial phase of D&e only but if the HbA1c doesn't reach 6.5 then medication should begin.
Having said all that, very few T2s can actually manage to get below 6.5 on D&E only - it would require real dedication and something like the Atkins Maintenance diet.
On top of that there is actually NO T2 diet or exercise regime in operation - D&e is just a vague phrase - T2s have to find out for themselves what it actually means.
And yet again Metformin is much more than bg reducer, its got other major health benefits as well e.g. strong heart protection ( which is a major issue for T2s since 80% of us die of heart disease).
T2 diabetes is a pernicious, deteriorating condition which affects all the microvascular and macrovascular aspects of the body, as well as being associated dyslipidemia and hypertension . Research suggests many if not most T2s have macrovascular damage by the time they come to be dxed. As such we should come out blasting at it with all guns blazing.
After 18 years at it, I say go for medication as soon as it is suggested and go for insulin whenever it is offered.
Six years into dx the average T2 is probably on metformin, another bg drug ( a sulf or a TZD), a statin for cholesterol, and a couple of drugs for hypertension. Its not inevitable but very possibly essential for most T2s.
 
Peter C said:
In late 2008 there was a big hoo-ha about T2s being put on metformin right at the start.
The Diabetes Uk Conference in Glasgow ( spring 2009) went big on the issue and suggested that T2s should be given a trial period on D&E only because it is essential for them to understand the absolute necessity for lifestyle and diet changes and not just think "I'm popping the pill and that's all I need to do".
NICE Guidelines also guarantee an initial phase of D&e only but if the HbA1c doesn't reach 6.5 then medication should begin.
Having said all that, very few T2s can actually manage to get below 6.5 on D&E only - it would require real dedication and something like the Atkins Maintenance diet.
On top of that there is actually NO T2 diet or exercise regime in operation - D&e is just a vague phrase - T2s have to find out for themselves what it actually means.
And yet again Metformin is much more than bg reducer, its got other major health benefits as well e.g. strong heart protection ( which is a major issue for T2s since 80% of us die of heart disease).
T2 diabetes is a pernicious, deteriorating condition which affects all the microvascular and macrovascular aspects of the body, as well as being associated dyslipidemia and hypertension . Research suggests many if not most T2s have macrovascular damage by the time they come to be dxed. As such we should come out blasting at it with all guns blazing.
After 18 years at it, I say go for medication as soon as it is suggested and go for insulin whenever it is offered.
Six years into dx the average T2 is probably on metformin, another bg drug ( a sulf or a TZD), a statin for cholesterol, and a couple of drugs for hypertension. Its not inevitable but very possibly essential for most T2s.
Click to expand...

Thank you for this reply - very interesting.
When I was diagnosed my fasting glucose was 7.1 and HbA1c was 6.2 so from what you are saying if I can keep my readings at this level then there is no need for the metformin.

My understanding is that Metformin works by stimulating the pancreas. I have chronic pancreatitis so my concern is that metformin may actually do more harm than good.

[Apologies for the delay in replying - blame a certain volcano!]
 
Ref said:
Thank you for this reply - very interesting.
When I was diagnosed my fasting glucose was 7.1 and HbA1c was 6.2 so from what you are saying if I can keep my readings at this level then there is no need for the metformin.

My understanding is that Metformin works by stimulating the pancreas. I have chronic pancreatitis so my concern is that metformin may actually do more harm than good.

[Apologies for the delay in replying - blame a certain volcano!]
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No I don't think metformin works by stimulating the pancreas. Sulfonylureas such as Gliclazide stimulate the pancreas to produce more insulin. Metformin operates on the liver to reduce glucose production by up to a third and it works on the cells, encouraging the uptake of glucose ( especially at the extremities).
 
When diagnosed my HbA1c was 13.3 and so was put on gliclazide immediately. Once my BG levels were under control, I was shifted on to metformin.

After a couple of months I had a chat with my GP and we agreed to stop the metformin too.

Since then, I've had a further two HbA1c tests (the last one being 6.2). So, it would seem that diet and exercise has been doing the trick for me.

Since diagnosis, I have also lost over 30lbs and my diet consists of a reasonable quantity of carbs (I'd say somewhere around 200g per day).

At my last meeting with the consultants, they were quite keen to get me back on the metformin and also start statins (I did have quite high cholesterol, but that was significantly reduced too). However, I was not keen because my progress so far doesn't indicate that it is necessary.

I refuse to pill-pop based on statistical evidence, no matter how compelling that evidence is!

Andy
 
metformin for pre diabetes

Clinical trials have shown that people at high risk for developing diabetes can be given treatments that delay or prevent onset of diabetes. The first therapy should always be an intensive lifestyle modification program because weight loss and physical activity are much more effective than any medication at reducing diabetes risk.

Several drugs have been shown to reduce diabetes risk to varying degrees. No drug is approved by the U.S. Food and Drug Administration to treat insulin resistance or pre-diabetes or to prevent type 2 diabetes. The American Diabetes Association recommends that metformin is the only drug that should be considered for use in diabetes prevention. Other drugs that have delayed diabetes have side effects or haven?t shown long-lasting benefit. Metformin use was recommended only for very high-risk individuals who have both forms of pre-diabetes (IGT and IFG), have a BMI of at least 35, and are younger than age 60. In the DPP, metformin was shown to be most effective in younger, heavier patients.
http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/#medicines
 
my nan is type two diabetic and has been on no form of medication for good few years now but that due to having problems with her heart and lungs which is not related to diabetes. She tests her sugar levels still and has blood tests ect like we do
 
tinsoomboon said:
Clinical trials have shown that people at high risk for developing diabetes can be given treatments that delay or prevent onset of diabetes. The first therapy should always be an intensive lifestyle modification program because weight loss and physical activity are much more effective than any medication at reducing diabetes risk.

Several drugs have been shown to reduce diabetes risk to varying degrees. No drug is approved by the U.S. Food and Drug Administration to treat insulin resistance or pre-diabetes or to prevent type 2 diabetes. The American Diabetes Association recommends that metformin is the only drug that should be considered for use in diabetes prevention. Other drugs that have delayed diabetes have side effects or haven?t shown long-lasting benefit. Metformin use was recommended only for very high-risk individuals who have both forms of pre-diabetes (IGT and IFG), have a BMI of at least 35, and are younger than age 60. In the DPP, metformin was shown to be most effective in younger, heavier patients.
http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/#medicines
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I don't have IGT (as far as I am aware) and my BMI is around 23 so on this basis the ADA would not recommend Metformin for me. So long as my next HbA1c test is OK, then I am going to resist the Metformin.


On a wider note, thank you everyone for your replies. I'm finding it difficult getting used to all the testing and thinking about what I am eating, or going to eat - particularly as CP requires a low fat diet at the same time. Your advice and information is invaluable.

Andy
 
Tinsoomboon is right, there have been studies (in sweden i think...,) that suggest that metformin is beneficial in people at risk of developing diabetes, however i don't think the NHS has enough cash to provide people "at risk" of things with regular medication (except maybe aspirin for heart disease and stroke but then i doubt you get it automatically. Or perhaps more acurately we're a long way from being able to acurately predict the chances of somebody developing type 2 diabetes.
Sorry i didn't reply to this thread earlier...i think my bs was somewhere around 19 when i was diagnosed, but the situation is complicated by the fact that i a) live alone and don't want to risk hypos and b)hate cooking and exercise😉. I also wasn't in the habit of seeing my GP, in fact i wasn't registered with one at the time., I'd been suffering from thirst, general malise and what i thought was cystitis for some time, but was too much of a dope to go to a doctor about it. Until i got blurred vision that freaked me into going to the minor injuries unit in the hospital where i work. Due to the fact that i'm under 35, and there was trace protein in my urine there was some speculation that i might be type one, in fact i was for about 12 hours, i got taken to a ward , put on an insulin infusion and discharged with insulin that night. The next day i got to see a DSN who decided that i was more likley to be type 2 (presumably blood results had come back) and had me put on Metformin, and register with a GP. Initally it was 500mg three times daily, and it brought by bs right down and since i've decreased to 500mg once daily.
Metformin doesn't affect that pancreas, although the exact mechanism of how it works isn't yet proven, it's thought to increase the uptake of insulin by the muscles. If you can tollerate the side effects it won't do you much harm, but isn't given to people with kidney problems (my grandfather got swoped from metformin to gliclazide about a year ago because his kidneys weren't up to it).
I do understand your reluctance to take medication if you feel you don't have to. It's you're decision and in fact, you're saving your local PCT a small ammount of money. You are incharge of your treatment (or so they tell me), it's your decision.

Rachel
 
I think it's very unlikely that all T2's will be put straight on to metformin in the future in light of the ACCORD study which indicated increased mortality in the intensive therapy glucose lowering arm of the study (they're not sure why this occurred but it's from this study that the recommendation against intensive therapy to get HbA1c lower than 7.5% originated - it's important to note that we are talking intensive pharmaceutical therapy here, not intensive D&E).

At the moment the HbA1c target for D&E control or one drug control is 6.5%; for more intensive treatment it's 7.5%. Rightly or wrongly, I guess there must be an informal cut-off point somewhere where the Dr decides that the patient is starting from such a high point that a three month D&E regime is pointless and metformin should be started straight away. I don't know what that cut-off point is. In my case my HbA1c was 7.1% at diagnosis and D&E was advocated strongly by my GP as the first option; no mention of metformin but a strong push for statins which is another issue altogether (I remain convinced that when T2's get their BG under control. the dyslipidaemia tends to sort itself out without recourse to statins).
 
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