December 7, 2023

The most common reason why patients undergo dialysis nowadays is type 2 diabetes mellitus (DM type 2),also called adult-onset diabetes mellitus. Prevention of this disease will translate into lower burden of kidney disease and kidney failure.

These factors put an individual at risk of developing DM type 2: 

1. Obesity 

2. Family history of DM in a first-degree relative 

3. Lack of exercise

4. Elevated blood pressure

5. Abnormal  cholesterol levels (dyslipidemia)

6. High-risk race or ethnicity: Asian, Hispanic, African American, Latino race

7. History of heart disease

8. Polycystic ovary syndrome in women

9. History of blood sugar elevation during pregnancy

10. Glycosylated hemoglobin level (HbA1c ) of 5.7- 6.4 percent ( 39-46 mmol/mol)

11. Impaired fasting blood sugar

There is no single prescription for all persons, but for persons at risk, 30 to 60 minutes of moderate intensity aerobic activity (like brisk walking) a day or at least 150 minutes per week has been shown to be helpful. Additional protection was provided by higher levels like 300 minutes per week. If exercise and other lifestyle modifications – weight loss, adequate sleep, control of blood uric acid, and dietary modifications fail, some medications are prescribed to prevent the development of DM type 2. Metformin is an inexpensive drug that has been proven to prevent diabetes among these persons at risk such as those less than 60 years old, those with body mass index of 35 kg/m2 or more, women with history of gestational diabetes, impaired fasting blood sugar, HbA1c of 5.7 to 6.4 percent. 

It decreases the production of glucose (body sugar) by the liver, decreases the absorption of glucose in the intestines, and increases so-called insulin sensitivity in the body. Glucose is more used up by the body so that blood sugar level does not increase. 

Metformin exerts its actions within days and maximum effects are seen up to two weeks. It does not promote weight gain and does not cause lowering of blood sugar (hypoglycemia). 

It should not be used however by individuals with severe kidney disease, whose kidney function less than 30 ml/min.

Its most common side effects are metallic taste in the mouth, decreased appetite, abdominal discomfort, or loose bowel movement. These are usually mild and temporary and disappear if the dose is decreased or the drug is discontinued. The drug may be stopped temporarily then resumed slowly at lower doses then gradually increased. Its use has been associated with decrease in vitamin B12 levels (Metformin decreases the absorption of the drug in up to 30 percent of patients) but this can be corrected with multivitamin supplementation and may be corrected with the use of calcium carbonate. 

Use of the drug should be under the supervision of a physician. Lifestyle intervention precedes its use. Its use and dose are modified depending on the goals of treatment and response of the individual. 

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