Study: Diabetics Face Drug Danger - Glucophage
 

Study: Diabetics Face Drug Danger
Tue May 14, 6:05 PM ET

By LINDSEY TANNER, AP Medical Writer

CHICAGO (AP) - A sizable number of diabetic patients with kidney disease or heart failure are inappropriately prescribed a common drug that could potentially kill them, a new study suggests.

Nearly one-fourth of patients whose prescriptions for the drug metformin were studied had at least one of those conditions despite labeled warnings against use in such patients.

Metformin, sold as Glucophage, can cause a rare side effect called lactic acidosis, a buildup of lactic acid in the blood that is fatal in about 50 percent of cases. Patients with heart disease or kidney failure are especially prone.

The drug package insert contains a black-box warning ? required by the government for drugs with potentially serious side effects ? and says it should not be used by patients with kidney disease or on drug treatment for heart failure.

While none of the 100 patients studied had developed lactic acidosis, the study "may underestimate the frequency of contraindications and it is difficult to determine whether clinicians are aware they are prescribing metformin against a black-box warning," the researchers said.

Lead researcher Cheryl Horlen said the problem isn't unique to the University of North Carolina-Chapel Hill hospital pharmacy where the study was done. University of Pittsburgh researchers and recent European studies found similar rates of inappropriate use.

More than 25 million prescriptions were written for metformin in 2000, according to the researchers.

Metformin helps the body use insulin and control blood sugar levels, and Horlen said patients shouldn't stop taking the drug without consulting their doctors.

The study is one of several on diabetes published in Wednesday's Journal of the American Medical Association (news - web sites ). It's the first JAMA issue devoted entirely to research on diabetes, which has reached epidemic levels and afflicts about 17 million people nationwide.

"I can't imagine anybody in the United States who doesn't have someone in their family or some close friend with diabetes," JAMA editor Dr. Catherine DeAngelis said.

Diabetes impairs the body's ability to produce or make proper use of insulin, resulting in elevated blood sugar levels that can damage the kidneys, heart, eyes and other organs.

Glucophage is among the most common drugs for Type II diabetes, which is linked to obesity and is sometimes called adult-onset, although it has started showing up in children.

Bonnie Jacobs, a spokeswoman for Glucophage maker Bristol-Myers Squibb Co., said the warnings "are clearly outlined" on the label.

Recent research from Harvard Medical School (news - web sites ) and Public Citizen Health Research Group suggested doctors don't pay close enough attention to drug warning labels, a problem also raised by the Food and Drug Administration (news - web sites).

Dr. Malcolm Taylor, president of the Association of Black Cardiologists, said patients' lack of knowledge about diabetes drugs might be partly to blame.

His group and the American Association of Diabetes Educators are launching a nationwide education campaign this week, including a new Web site to raise awareness about the link between diabetes and heart disease, the leading cause of diabetes-related death.

In other JAMA research, a Kaiser Permanente study suggests that giving blacks and whites similar health care access can help ease racial disparities in rates of complications such as severe kidney disease, which affects blacks disproportionately.

However, the study of 62,432 patients enrolled in a northern California Kaiser insurance plan found some differences persisted despite equal access, suggesting genetic differences may help explain the racial disparities, Kaiser scientist Andrew Karter said.

In a JAMA editorial, Dr. Christopher Saudek, president of the American Diabetes Association, said the studies underscore the need for insurers and policy-makers to adequately address chronic diseases like diabetes, which require a lifetime of treatment.

"We should be paying to keep people out of the hospital, to keep them as pain-free as possible and as free from complications," Saudek said.


http://story.news.yahoo.com/news?tm...betes_journal_3

Thanks for a very informative post! This is probably why my doctor insists on doing liver and kidney function blood tests every 6 months. I've pretty much weaned myself off the Glucophage over the past few months with no perceptible change in my blood sugars (yeah!) and hope to never have to go on it again!

I have blood tests every 3 months. I want off my medication soooo bad!!. I was am going to the Doctor in two weeks and I am going to try to get off one of them. Hopefully, I can also get off the glucophage when I take off about 50lbs.

Lisa N. Your starting number is similar to mine. I hope to follow in your footsteps. How much weight had you lost before you started weaning off the medication?

Crafty...If I remember correctly, it was about 3 months after I started low carbing and I had already dropped to about 215 lbs. My blood sugars started dropping a little too low on the full dose of Glucophage while I was on vacation, so I started taking a half dose and my blood sugars stayed good. I told my doctor about it as soon as we got back and he was fine with it as long as my blood sugars stayed in the normal range. I think by the time I got down to around 200 lbs, I was able to maintain my blood sugars without it as long as I didn't eat anything high in carbs. Of course, everyone is different, so your experience may not be the same as mine but I think that following this WOE is the surest way that you will be able to eventually get off the medications if that is possible for you. Some people continue to need their medications, although at a much lower dose than before. Work closely with your doctor in this and don't quit taking your meds without consulting him (or her) first. I made a decision because I was on vacation and getting to a phone would have been difficult, but I was also checking my blood sugars 5 times a day at that point, so I would have known immediatly if cutting my meds had a negative effect. Good luck to you!

I'm on metformin (Glucophage), 1000-1500 mg a day. This is the first time I've been on low carb (tried it 7 years ago for 3-4 months) that I wasn't fighting carb cravings all day, every day. In me, they manifest not only as an intense desire to eat anything with sugar, but with deep, deep depression that comes on so sneakily that I start thinking about death and how great a release that would be and have to really pull myself together and understand that it's not real, just temporary. What a relief the metformin is for me. It prevents the carb cravings and will stop them if I take it after they start and hang in there for just an hour or 2.
I have had a full blood workup and the doctor said my liver, kidney, blood pressure, etc. were "beautiful" so I assume I am not at risk.

I have been trying to wean myself off, but even taking these meds for the rest of my life is preferable to the depression and taking a chance of not having the rest of my life.

I think the effective word in the warning is: "rare". The warning is true, just read the patient information pamphlet that comes with the drug. Here's another 'heads-up' on drugs: Diuretics prescribed for high blood pressure (thiazides). They actually RAISE blood sugar!! But did my doctor tell me that? NOOO. However, the handy pamphlet did. I took myself off them, and voila! Two days later my blood sugar came down an average of 20 mg/dl. Told the doc, had him increase my ACE inhibitor instead. Also to those who are taking glucosamine who are diabetic...stop. It also raises blood sugar. Concerned about arthritis? Just eat more gelatin. (my two cents...)