Comparison of gastrointestinal adverse events with different doses of metformin in the treatment of elderly people with type 2 diabetes

Abstract

What is known and Objective: Gastrointestinal discomfort is the most common adverse event of metformin treatment for type 2 diabetes, especially in elderly patients.The aim of this study was to compare gastrointestinal adverse events resulting from different doses of metformin used for the treatment of elderly people with type 2 diabetes.Methods: A total of 361 elderly patients with newly diagnosed diabetes were randomly divided into three groups: metformin 1000 mg/d (N = 120), metformin 1500 mg/d (N = 121) and metformin 2000 mg/d (N = 120). Glycaemic control and gastrointestinal adverse events (abdominal pain, diarrhoea, nausea, vomiting, bloating and anorexia) were assessed and compared among the three groups after 12 weeks of treatment.Results and discussion: At baseline, there was no significant difference in gastrointestinal symptoms among the three groups. After 12 weeks of treatment with metformin, the change in HbA 1c level was −0.7%, −0.9% and −1.0% for the 1000 mg/d, 1500 mg/d and 2000 mg/d groups, respectively (P < .0001). There was no significant difference in gastrointestinal adverse events among the three groups after treatment with metformin. In total, 62 people (17.2%) could not tolerate the adverse effects of metformin, and most of them stopped treatment in the first 4 weeks. Logistic regression analysis shows that female sex (OR = 2.660, 95%CI 1.692-4.183, P < .0001) and the concurrent use of organic cation transporter 1-inhibiting drugs (OR = 1.874, 95%CI 1.076-3.265, P = .027) are independent risk factors for adverse events. What is new and conclusions:Our data demonstrate that metformin doses of 1000 mg/d-2000 mg/d have similar adverse events but that 2000 mg/d of metformin yields the best glycaemic control in elderly people with diabetes. If elderly people can tolerate 1000 mg/d of metformin, we could gradually increase the dose to 2000 mg/d to achieve better glycaemic control. K E Y W O R D S elderly, gastrointestinal adverse events, metformin, type 2 diabetes | 471 YUXIN et al.

Efficacy of canagliflozin versus metformin in women with polycystic ovary syndrome: A randomized, open‐label, noninferiority trial

“…The frequency of pruritus vulvae with canagliflozin osmotic diuresis‐related AEs was increased compared with metformin, which is consistent with previous reports 46,47 . In the present study, the incidence of AEs with metformin treatment was much higher than that in other trials, but is consistent with a previous study on elderly Chinese people with diabetes, which showed that 196 patients (54.3% of the study population) experienced at least one AE 48 . This phenomenon of high AE incidence in the present study may be explained by the all‐female study population and the presence of comprehensive records (including temporary response) and information bias, since this study was open‐label.…”

“…46,47 In the present study, the incidence of AEs with metformin treatment was much higher than that in other trials, but is consistent with a previous study on elderly Chinese people with diabetes, which showed that 196 patients (54.3% of the study population) experienced at least one AE. 48 blood pressure, whereas a previous study showed that no blood pressure changes were demonstrated in PCOS patients taking empagliflozin. 24 Third, given that this study was designed as a single-centre, open-label study, and not a multicentre, blinded study, our findings, particularly those pertaining to the multiple secondary outcomes investigated, might be attributable to chance.…”

Medical Management of Obesity as it Affects Reflux

“…15,56 The most common side effects of metformin are abdominal pain, bloating, nausea, and diarrhea, which can be mitigated by dose titration or extended-release preparations. 57 Our searches returned no studies directly examining the effect of metformin on parameters of reflux. Famotidine may improve the bioavailability and simultaneously enhance the renal clearance of metformin, and may transiently augment metformin's hypoglycemic effects.…”

Gut microbiota is correlated with gastrointestinal adverse events of metformin in patients with type 2 diabetes

“…Patients enrollment and study protocol 50 antidiabetic agents treatment-naïve patients with newly diagnosed type 2 diabetes, aged≥60 years, with body mass index≥18.5 kg/m 2 and Hemoglobin A1c (HbA1c) of 7.0%-9.0% were enrolled from a previous study (7). The exclusion criteria included the following: (a) confirmed or suspected type 1 diabetes; (b) previous treatment with insulin or other antidiabetic drugs for more than 14 days; (c) a history of known peptic ulcers, Helicobacter pylori infection, gastrointestinal surgery, chronic gastritis, gastrointestinal tumor or severe gastrointestinal discomfort; (d) current (within 3 months of screening) diabetic ketoacidosis or hyperosmolar coma; (e) current cardiovascular disease or other serious disease; (f) a creatinine clearance rate <60 mL/min; (g) liver enzymes more than 2 times the upper limit of normal at screening; (h) use of unknown combination drugs; and (i) poor drug compliance.…”