The History of Metformin

Metformin is one of the most commonly used medications in endocrinology. It is the preferred first-line oral blood glucose-lowering medicine to manage type 2 diabetes. It is also used in the treatment of polycystic ovary syndrome. Sometimes it is used, along with other medications, to treat infertility.

The journal Diabetologia dedicated a special issue this month to Metformin, which is celebrating 60 years of clinical use.

Most people don’t know that metformin has been in use for sixty years! The effectiveness of the plant from which metformin is derived has been known since 1918. The plant Gallegos officinalis (goat’s rue, also known as French lilac or Italian fitch) was noted to have sugar-reducing properties then. Initial experiments with metformin went well, but the discovery of human insulin for the treatment of diabetes put metformin on the back-burner. Metformin was rediscovered in the 1940s. The French physician Jean Sterne was the first to pursue the glucose-lowering effect of metformin. He reported the use of metformin to treat diabetes in 1957.

Over the years, the ability of metformin to improve the way the body processes and responds to insulin was appreciated more and more through Europe. After intensive research, metformin was introduced into the USA in 1995.

Long-term benefits on heart health were identified by the UK Prospective Diabetes Study (UKPDS) in 1998. This provided yet another reason for metformin to become first-line treatment for diabetes.

Sixty years after its introduction, metformin has become the most prescribed sugar-lowering medicine worldwide with the potential for other uses.

Metformin timeline
1772 Galega officinalis used anecdotally to treat symptoms of diabetes
1929 First scientific experiments on lab animals
1957 Jean Sterne publishes on the use of metformin to treat diabetes
1958 Metformin introduced as a diabetes medication in the UK
1994 Metformin introduced in the USA
1998 UKPDS reports heart benefits of metformin in people with type 2 diabetes
2002 Metformin shown to reduce progression of prediabetes to diabetes
2011 Metformin included in the essential medications list of the World Health Organization

For further insights into the history and multiple uses of metformin – see Diabetologia (2017) 60

New Medication Option for Osteoporosis Treatment

The Food and Drug Administration (FDA) has approved Tymlos (abaloparatide) injection for the treatment of postmenopausal women with osteoporosis at high risk for fracture. High risk for fracture is defined as history of osteoporotic fracture, multiple risk factors for fracture, or patients who have failed or are intolerant to other available osteoporosis therapy. In postmenopausal women with osteoporosis, Tymlos reduces the risk of vertebral and nonvertebral fractures.

Clinical Data

The FDA’s approval of Tymlos was based on results from the ACTIVE trial and an extension of this trial. These studies demonstrated significant reductions in the risk of vertebral and nonvertebral fractures regardless of age, years since menopause, presence or absence of prior fracture and bone mineral density (BMD) at baseline. In clinical studies, Tymlos reduced the incidence of new vertebral and nonvertebral fractures, and increased bone mineral density (BMD).

The results from the ACTIVE trial were published in the Journal of the American Medical Association in August of 2016, and the results of the first six months of ACTIVExtend were published in the Mayo Clinic Proceedings in February 2017.

Specifically, in the ACTIVE trial, TYMLOS demonstrated significant reductions in the relative risk of new vertebral and nonvertebral fractures compared to placebo in the ACTIVE trial of:

  • 86% in new vertebral fractures
  • 43% in nonvertebral fractures

The absolute risk reductions were 3.6% and 2.0%, respectively.

Safety information

Abaloparatide caused a dose-dependent increase in the incidence of osteosarcoma (a malignant bone tumor) in male and female rats. The effect was observed at systemic exposures to abaloparatide ranging from 4 to 28 times the exposure in humans receiving the 80 mcg dose. It is unknown if Tymlos will cause osteosarcoma in humans.

For this reason, the use of Tymlos is not recommended in patients at increased risk of osteosarcoma including those with Paget’s disease of bone or unexplained elevations of alkaline phosphatase, open epiphyses, bone metastases or skeletal malignancies, hereditary disorders predisposing to osteosarcoma, or prior external beam or implant radiation therapy involving the skeleton.

Adverse Reactions: The most common adverse reactions (incidence ≥2%) are hypercalcemia, hypercalciuria, dizziness, nausea, headache, palpitations, fatigue, upper abdominal pain and vertigo.

Reminders About Osteoporosis

Osteoporosis is a silent disease, often displaying no signs or symptoms until a fracture occurs, leaving the majority of people with osteoporosis undiagnosed and untreated. Osteoporotic fractures create a significant healthcare burden. An estimated two million osteoporotic fractures occur annually in the United States, and this number is projected to grow to three million by 2025.

The National Osteoporosis Foundation (NOF) has estimated that eight million women already have osteoporosis, and another approximately 44 million may have low bone mass placing them at increased risk for osteoporosis

Screening is key to diagnose osteoporosis. Once osteoporosis is diagnosed, it is very important to undergo a thorough evaluation to look at secondary factors that can contribute to osteoporosis. Once the evaluation is complete, you and your physician can review the best treatment plan for you.

One of world’s most prestigious endocrinology conferences comes to Austin!

Texas Diabetes & Endocrinology was excited about one the world’s largest endocrinology conferences being in Austin this year. The Annual Scientific & Clinical Congress of the American Association of Clinical Endocrinologists was held in Downtown Austin between May 3rd and 7th. This is a world-renowned meeting which highlights the latest technological and medical advances in endocrinology. The program included expert speakers covering the latest developments and workshops presenting cutting-edge research to practitioners from around the world.

The most recent developments in diabetes treatment received extensive coverage at the conference. Dr. Thomas Blevins from Texas Diabetes & Endocrinology presented our clinic’s early experience with the new closed-loop insulin pump system in patients with type 1 diabetes.

In other sessions, attendees learned about recent developments in diabetes care. A special workshop reviewed data from recent studies evaluating the impact of diabetes medications on heart health.

One of the messages was that good sugar level control can have a significant impact on heart health. A study published in Diabetologia, showed that about 2.5% of patients with type 2 diabetes had known heart failure. Further detailed evaluation showed that up to 27.7% of patients had early signs or findings of heart failure. Importantly, by using medications that are known to reduce the risk of heart disease in patients with diabetes we can prevent the development and progression of these early stages of heart problems.

The special session also touched on different diabetes medications and their effects on heart function. The EMPA-REG outcome study which showed a significant reduction in heart disease and stroke-related deaths with the use of empagliflozin was reviewed. Another agent, liraglutide also reduced cardiovascular deaths, and the study that demonstrated this finding was the LEADER study.

The meeting was a major success overall, and it was a great opportunity for Texas Diabetes & Endocrinology providers to show off their city to colleagues from around the world!

Texas Diabetes & Endocrinology is awarded AlUM Ultrasound Practice Accreditation

The Ultrasound Practice Accreditation Council of the American Institute of Ultrasound in Medicine is pleased to announce that Texas Diabetes & Endocrinology has been awarded practice accreditation in the area of thyroid ultrasound.

Texas Diabetes & Endocrinology achieved this recognition by meeting rigorous voluntary guidelines set by the diagnostic ultrasound profession. All facets of the practice were assessed, including the training and qualifications of physicians and sonographers; ultrasound equipment maintenance; documentation; storage, and record-keeping practices; policies and procedures to protect patients and staff; quality assurance methods; and the thoroughness, technical quality and interpretation of the sonograms the practice performs.

About the AIUM

The American Institute of Ultrasound in Medicine is a multidisciplinary medical association of more than 9900 physicians, sonographers, and scientists dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation. Participation in the AlUM’s Ultrasound Practice Accreditation program is available to practices in the following areas of ultrasound: abdominal/general, breast, complete obstetric or trimester-specific obstetric, OB with adjunct detailed fetal anatomic ultrasound, musculoskeletal (diagnostic), musculoskeletal (ultrasound-guided interventional procedures), fetal echocardiography, gynecologic (with or without 3D), dedicated thyroid/parathyroid, urologic, ultrasound-guided regional anesthesia and head and neck. For more information, visit www.aium.org.

Dr. Luis Casaubon Achieves American Board of Internal Medicine Recertification

Congratulations to Dr. Casaubon at our Central Austin office for completing all the required stages, and achieving recertification in Diabetes, Endocrinology and Metabolism. All our endocrinologists are board certified by the American Board of Internal Medicine. In order to maintain board certification, a specialist needs to take a comprehensive exam every ten years, and fulfill rigorous continuing education requirements. Dr. Casaubon successfully passed his recertification exam, and demonstrated completion of continuous education requirements. All our specialists maintain their specialty board certification as a way to demonstrate their commitment to staying up to date on the newest developments in their field for excellent patient care.

Groundbreaking Ceremony at New Round Rock Office

Construction at our new Texas Diabetes & Endocrinology office in Round Rock has started. The new building will allow us to serve our patients better by integrating our weight loss program, our research department, and will expand our clinic space. Our patients will also appreciate the increased parking space. The new building will be at 110 Deer Ridge Dr. We are expecting to move in to the new space this summer, and we will keep our patients posted.

Continuous Glucose Monitors (CGMs) – Gold Standard of Care for Adults with Type 1 Diabetes

The Endocrine Society recently issued a Clinical Practice Guideline recommending continuous glucose monitors (CGMs) as the gold standard of care for adults with Type 1 diabetes. Here at Texas Diabetes & Endocrinology, we provide comprehensive training and support for continuous glucose monitoring.

The guideline, titled “Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline,” was published online and also appeared in the November 2016 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of the Endocrine Society.

Continuous glucose monitors (CGMs) are primarily used to help in the management of Type 1 diabetes, although the devices can be useful for people with type 2 diabetes, as well.

Studies have found that people with Type 1 diabetes who use CGMs are able to maintain better control of their blood sugar without increasing episodes of hypoglycemia when blood sugar drops to dangerous levels, compared to those who self-monitor blood glucose with periodic fingersticks,” said Anne L. Peters, MD, of the University of Southern California’s Keck School of Medicine in Los Angeles, CA, and chair of the task force that authored the guideline. “Scientific evidence supports the use of CGM technology in individuals with Type 1 diabetes whose blood sugar is above the targeted level as well as those whose blood glucose is well managed.”

Texas Diabetes & Endocrinology Partners with MyDiabetesHome

Texas Diabetes & Endocrinology is proud to announce our new partnership with MyDiabetesHome.  MyDiabetesHome.com is a personalized diabetes management platform providing diabetic patients with tools to track  blood sugar and manage medications. The interactive dashboard is easily accessible via computer, tablet or mobile device and allows patients to simplify their life, drastically improve doctor visits, and ultimately achieve better health. Texas Diabetes & Endocrinology will be sponsoring an upgraded membership for all patients. Check it out today!  www.mydiabeteshome.com

FDA approves first automated insulin-delivery device for type 1 diabetes

The FDA announced the approval of Medtronic’s MiniMed 670G, the first hybrid closed loop system – often referred to as an “artificial pancreas” – on September 28th. The device is designed to check sugar levels, and provide appropriate insulin doses, based on those readings. It is currently approved for use for people aged 14 years and older with type 1 diabetes.

 The FDA emphasized its dedication to making technologies available that can help improve the quality of life for those with chronic diseases — especially those that require day-to-day maintenance and ongoing attention in a press release. The press release said: “This first-of-its-kind technology can provide people with type 1 diabetes greater freedom to live their lives without having to consistently and manually monitor baseline glucose levels and administer insulin.”

The new device measures glucose every five minutes and automatically administers or withholds insulin, based on these levels. Users will still need to manually administer insulin doses for mealtime insulin.

The system includes a sensor that monitors glucose levels under the skin, an insulin pump, and an infusion patch.

Data from a clinical study including 123 participants with type 1 diabetes showed safety and effectiveness of the device for people aged 14 years and older.

An ongoing study is currently looking at the safety and effectiveness of the system for children aged 7 to 13 years with type 1 diabetes.

More information about the device can be found here: http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2206594