Metformin: an Old Therapy that Deserves a New Indication for the Treatment of Obesity
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Metformin is not currently used for weight loss or diabetes prevention because it lacks an FDA indication for obesity and/or pre-diabetes treatment. Based on the evidence, metformin has been shown to decrease the incidence of type 2 diabetes, and compares favorably to other weight-loss medications in terms of efficacy as well as safety. Thus, metformin should be considered for a treatment indication in patients with these conditions.
KeywordsMetformin Obesity Pre-diabetes Diabetes prevention
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Conflict of Interest
Dr. Igel, Dr. Sinha, and Dr. Saunders declare that they have no conflict of interest.
Dr. Apovian declares to have participated on advisory boards for Amylin, Merck, Johnson and Johnson, Arena, Nutrisystem, Zafgen, Sanofi-Aventis, Orexigen, EnteroMedics, GI Dynamics, Novo Nordisk and Scientific Intake; to having received research funding from Lilly, Amylin, Aspire Bariatrics, GI Dynamics, Pfizer, Sanofi-Aventis, Orexigen, MetaProteomics, the Dr. Robert C. and Veronica Atkins Foundation, MYOS Corporation and Takeda; and to currently being on the Takeda Speakers Bureau for the medication Contrave.
Dr. Vojta declares to be an employee at UnitedHealth Group.
Dr. Aronne declares consultant/advisory board work with Jamieson Labs, Pfizer Inc, Novo Nordisk A/S, Eisai, VIVUS, GI Dynamics, JOVIA Health, and Gelesis; to be a shareholder for Zafgen, Gelesis, Myos Corporation, and Jamieson Labs; to be on the Board of Directors with MYOS Corporation and Jamieson Labs; and for having research funding from Aspire Bariatrics and Eisai.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.World Health Organization. WHO—obesity and overweight fact sheet. 2015. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/.
- 3.Centers for Disease Control and Prevention. National Diabetes Statistics Report: estimates of diabetes and its burden in the United States, 2014. Atlanta: U.S. Department of Health and Human Services; 2014.Google Scholar
- 5.Matthew Kasman, Ross A. Hammond, Aurite Werman, Austen Mack-Crane and RAM. Brookings Institution: An in-depth look at the lifetime economic costs of obesity; 2015Google Scholar
- 9.Bristol-Myers Squibb Company. Glucophage XR package insert. Princeton, NJ; 2009. Available at: http://packageinserts.bms.com/pi/pi_glucophage_xr.pdf.
- 13.•Diabetes Prevention Program Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care. 2012;35(4):731–7. This study examined the effect of metformin on weight loss in the Diabetes Prevention Program Outcome Study (DPPOS). It demonstrated that weight loss was related to adherence to metformin, and was durable for at least 10 years of treatment.CrossRefGoogle Scholar
- 14.••Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–62. This publication denotes the first clinical practice guidelines for the pharmacological management of obesity. These guidelines were drafted by an Endocrine Society-appointed task force of experts, and were co-sponsored by the European Society of Endocrinology and The Obesity Society.CrossRefPubMedGoogle Scholar
- 28.•Domecq JP, Prutsky G, Leppin A, et al. Clinical review: drugs commonly associated with weight change—a systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100(2):363–70. The authors completed a systematic review and meta-analysis of 54 commonly precribed drugs to summarize the evidence about their association with weight change. Weight loss was associated with the use of metformin (1.1 kg), acarbose (0.4 kg), miglitol (0.7 kg), pramlintide (2.3 kg), liraglutide (1.7 kg), exenatide (1.2 kg), zonisamide (7.7 kg), topiramate (3.8 kg), bupropion (1.3 kg), and fluoxetine (1.3 kg).CrossRefPubMedGoogle Scholar
- 33.Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352(9131):854–65.Google Scholar
- 46.Glintborg D, Altinok ML, Mumm H, Hermann AP, Ravn P, Andersen M. Body composition is improved during 12 months’ treatment with metformin alone or combined with oral contraceptives compared with treatment with oral contraceptives in polycystic ovary syndrome. J Clin Endocrinol Metab. 2014;99(7):2584–91.CrossRefPubMedGoogle Scholar
- 56.National Cancer Institute—obesity and cancer risk. 2012. Available at: http://www.cancer.gov/cancertopics/causes-prevention/risk/obesity/obesity-fact-sheet.
- 57.•Goodwin PJ, Parulekar WR, Gelmon KA, et al. Effect of metformin vs placebo on and metabolic factors in NCIC CTG MA.32. J Natl Cancer Inst. 2015;107(3):djv006. This study examined the effects of metformin on metabolic factors in patients with breast cancer. The NCIC Clinical Trials Group (NCIC CTG) illustrated that metformin improved weight, insulin, glucose, leptin, and CRP at six months.CrossRefPubMedPubMedCentralGoogle Scholar
- 63.•Flory JH, Hennessy S. Metformin use reduction in mild to moderate renal impairment: possible inappropriate curbing of use based on food and drug administration contraindications. JAMA Intern Med. 2015;175(3):458–9. The authors propose use of estimated glomerular filtration rates (eGFRs) as a better measure of renal function than serum creatinine levels in determining contraindications to metformin use, and suggest that the FDA revisit metformin’s current contraindication in patients with mild renal insufficiency.CrossRefPubMedGoogle Scholar