"Just over a year ago Catherine Price decided to start taking one of the cheapest safest oldest most widely prescribed drugs for Type  diabetes. So much metformin is taken in the United States  some  million prescriptions were written http_US_Use_of_Meds_for_.pdf for it in   that a recent study  httpsurldefense.proofpoint.comvurluhttpA___pubmed_dBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomPFajanIWGAFEHgUJhkyonOF_PHJUOTbpHqTRVneIsoeVrhISACdkHWfCnChgYPAIC_ueKMrIoefound higher trace levels of it presumably from the urine of people taking it in Lake Michigan than of any other drug including caffeine.  But Price a science and medical reporter in Oakland Calif. doesnt have Type  diabetes. She has Type  the far less common form of the disease which requires lifelong treatment with insulin to compensate for her bodys failure to produce enough of the hormone. However she had read studies indicating that metformin combined with insulin might help Type  diabetics too. Moreover the drug was being studied in clinical trials as a way to lower the risk of cancer httpsurldefense.proofpoint.comvurluhttpA___pubmed_FtermDcancerBmetformindBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomPFajanIWGAFEHgUJhkyonOF_PHJUOTbpHqTRVneIsKbF_rmOjqVTYzZIncneeytoAAgpNaeBHMe heart disease  httpsurldefense.proofpoint.comvurluhttpA___pubmed_FtermDcardiacBmetformindBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomPFajanIWGAFEHgUJhkyonOF_PHJUOTbpHqTRVneIsA_kIkBcZILNdcZRU_wjzoPxFywYLxpwMJGLyPnIeand dementia  httpsurldefense.proofpoint.comvurluhttpA___pubmed_FtermDdementiaBmetformindBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomPFajanIWGAFEHgUJhkyonOF_PHJUOTbpHqTRVneIsHQVXHzMsirGLykhxba_dKjUflGmywjpCOnfolYe not just for diabetics but for everyone. For Price there was yet another possible benefit  as a treatment for polycystic ovary syndrome an endocrine disorder that doctors thought might explain the difficulty she and her husband had had conceiving. Sure enough a month and a half after she had started taking metformin pills and even as she was enjoying the benefits of better bloodsugar control Price became pregnant eventually giving birth to a girl. Im still taking metformin along with my insulin said Price  who was diagnosed with Type  diabetes  years ago. I remember eating Mexican food one night which can be a potential disaster for people with diabetes because of the carbs but I noticed I needed only twothirds to a half of the insulin I normally needed. Synthesized in the s metformin was first approved for treatment of Type  diabetes in the United Kingdom in . It took until  to get approval in the United States after a potentially fatal disorder linked to a similar drug was found to be rarely if ever associated with metformin httpsurldefense.proofpoint.comvurluhttpA__care.diabetesjournals.org_content___.fulldBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomDTTcedfhHHioJ_KDMcebDTlBgcryFTJzIYsysDwsxusouQcHnZwywiTA_gOKnCRdlUgnGIe. Unlike insulin shots which help Type  diabetics break down sugar and starches in the blood metformin lowers bloodsugar levels primarily by squelching the livers tendency to release storedup sugar into the bloodstream. Keeping that extra sugar actually a form of sugar called glucose out of the blood helps to maintain normal bloodsugar levels thereby preventing such longterm complications as blindness kidney failure and lowerlimb amputation. About  million people in the United States have diabetes according to the Centers for Disease Control and Prevention. More than  percent of them have Type  in which their bodies slowly fail to respond to normal levels of insulin forcing their pancreas to produce so much that its eventually exhausted. The estimated . million with Type  in contrast lose their ability to produce insulin usually within a matter of months due to an autoimmune attack by the body on itself. Today the range of ailments being targeted by metformin a prescription drug sold under such names as Glucophage Glumetza Fortamet and Riomet all share one characteristic They are diseases related to aging. Metformin actually lowers the rate of cell turnover said Michael Pollak who has been studying metformins effects on pancreatic cancer as chairman of oncology at McGill University in Montreal. It makes cells divide less quickly. The rateofliving theory defines aging as the number of cell divisions you undergo since you were a fertilized egg. If the theory is true then people who age more gracefully have a slower rate of cell division. The question is whether the rateofliving theory is operational in mammals. Pollak says that none of the most exciting possible benefits for the drug have yet been proved in randomized clinical trials of nondiabetics. For now the evidence suggesting benefits is limited to large studies of diabetics that have found on average that those who take metformin tend to have lower rates of cancer heart disease and dementia and to live longer  httpsurldefense.proofpoint.comvurluhttpA___pubmed_FtermDlongevityBmetformindBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomDTTcedfhHHioJ_KDMcebDTlBgcryFTJzIYshLsxmJKHzEViLsqrYnEXzeaMDQxDTICrtkFUeoverall than those who take other drugs for diabetes. Those effects have also been seen in animal studies. But such evidence often does not pan out in human studies. At a medical meeting in May Pollak reported disappointing results from his first randomized placebocontrolled trial of metformin for people with pancreatic cancer. It yielded no benefit he said. Plain old metformin given in the same dose as we do for Type  diabetes doesnt seem to be a breakthrough for cancer at least for pancreatic cancer. Many other metformin clinical trials are underway for breast httpsurldefense.proofpoint.comvurluhttpA___pubmed_FtermDbreastBcancerBmetformindBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomDTTcedfhHHioJ_KDMcebDTlBgcryFTJzIYsrNXgzShcqbedWgrLivcCzIegwNNxkCWnLNAe colorectal http endometrial httpsurldefense.proofpoint.comvurluhttpA___pubmed_FtermDendometrialBcancerBmetformindBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomDTTcedfhHHioJ_KDMcebDTlBgcryFTJzIYsioHnZzhozhsfzlAfFVvsgUpeEFSlPxYcoYe and other cancers. For heart disease the benefit of metformin over most other drugs for Type  diabetics has been seen repeatedly in clinical trials httpsurldefense.proofpoint.comvurluhttpA___pubmed_FtermDmetforminBcardiacBdiabetesdBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomPFajanIWGAFEHgUJhkyonOF_PHJUOTbpHqTRVneIslBuanmLJ_nLVYDP_vOewkvZAppQWcrYREkIuOVoe. For people without diabetes only one study httpsurldefense.proofpoint.comvurluhttpA___pubmed_dBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomPFajanIWGAFEHgUJhkyonOF_PHJUOTbpHqTRVneIsaURSluuYtfUPvkIDprJMRLpSHL_cTAgJfQe has been published finding no apparent effect after  months. As with cancer however other studies are underway. For dementia which people with Type  diabetes have double the risk of developing compared with nondiabetics metformin has been found  httpsurldefense.proofpoint.comvurluhttpA___pubmed_dBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomPFajanIWGAFEHgUJhkyonOF_PHJUOTbpHqTRVneIsoDWkvFUjSHpj_EVuLCxPnBeebCeQxkhCWIoein a number of studies to cut that risk substantially. Theres been a lot of excitement about metformin and dementia said Rachel Whitmer an epidemiologist at Kaiser Permanente in California. In  Whitmer presented the results of a study of about  people newly prescribed a medication for Type  diabetes By the end of the fiveyear study those who received metformin had a  percent lower risk of having developed dementia than those prescribed sulfonylureas another common type of diabetes drug. But Whitmer notes I dont think the story is complete. There needs to be more work in this area with all drugs for diabetes. For Type  diabetes researchers at the University of Colorado Denver School of Medicine published a study http in May in which they added either a low dose of metformin or placebo pills to the insulin regimen of  adolescents. Those who received metformin lost weight  generally a benefit for those with diabetes  and needed less insulin after six months. Those who received the placebo needed more insulin than at the beginning of the study and saw their blood pressure rise. The one goal the study did not achieve was better bloodsugar control. There is some benefit but it wasnt the full benefit we hoped for said Helen Nickerson senior scientific program manager at JDRF formerly known as the Juvenile Diabetes Research Foundation which partly funded the study. Even so she said she is hearing from doctors that growing numbers of them are prescribing metformin along with insulin to patients with Type  diabetes. No one would suggest that a person with Type  diabetes stop taking their insulin. Doing so would be lifethreatening. For those with Type  metformin is being tested only as an addon to insulin. JDRF meanwhile is funding a clinical trial to see if metformin will reduce the risk of heart disease in people with Type  and it is funding a trial in Britain to see if the drug will prevent children from developing Type  in the first place. Terry Wilkin a professor of endocrinology and metabolism at the University of Exeter is leading the prevention trial. He theorizes that the risk of developing Type  rises when excess demand for insulin is placed on the pancreas in children who are even slightly overweight. His study will give low daily doses of metformin to children who are at high risk of developing Type . If we can even slightly lower their average blood sugar with metformin Wilkin said I believe we can have a big benefit on their risk of developing Type . Despite all these potential benefits of metformin  and despite a recommendation from the American Diabetes Association that it be tried before any other drug for newly diagnosed Type  diabetics  a recent study httpsurldefense.proofpoint.comvurluhttpA___pubmed_dBQMFaQcRAhzPLrCAqeJdrcQiUVEwFYoMRqGDAXQ_puwtYjgrGgivkKNHTVnLjjXizEdTOTAeiQkcgtAvxxZaomPFajanIWGAFEHgUJhkyonOF_PHJUOTbpHqTRVneIsFdHbWleggxgLxctVZVYIAGcDznQHdEJvhYe found that only about half of all such people get metformin as their first prescribed medication. The study does not explain why that might be. Among the possibilities experts say are that newer drugs are being pushed heavily in directtopatient advertising and that some patients are turned off by the common though mild side effect of metformin  stomach upset and diarrhea  which can usually be avoided by starting on a low dose. The author of the study Niteesh Choudhry an associate professor of medicine at Harvard Medical School also found that newly diagnosed Type  diabetics who start on metformin are the least likely to need an additional diabetes drug later. Its clear that physicians and patients are not always choosing to start on metformin he said. There are legitimate reasons to put patients on one drug rather than another. But the guidelines do recommend metformin first. For patients with Type  whose doctor started them on a drug other than metformin he said I certainly would encourage people to talk with their doctor. Thats always a good thing. Hurley is a New Jerseybased science journalist who writes frequently on diabetes and health."