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  • Writer's pictureFandy Ting

糖尿病百寶箱:被遺忘了的饋寶 The Diabetes Treasure Chest: A Forgotten Gift










Endocrinologist Dr Ting Zhao Wei Rose

Over a decade ago, there were only a few types of common oral medications for diabetes. In the past ten years, however, we have witnessed a fruitful era in diabetes treatment, with the emergence of many new drugs that combat diabetes in various ways while having fewer side effects. This has enriched the "diabetes treasure chest" for doctors with new valuable options. Nevertheless, amid this wave of new drugs shining brightly, there is one medication that has been used for decades and remains a first-line treatment for diabetes—Metformin.

More than 95% of diabetes patients have type 2 diabetes, where the primary cause is the body's insufficient sensitivity to insulin (known as insulin resistance), leading to high blood sugar levels. Metformin specifically targets insulin resistance, reducing glucose production in the liver and increasing the absorption of excess glucose by muscle tissues. As a result, it effectively lowers blood sugar levels without causing hypoglycemia as a side effect.

Traditionally, Metformin needed to be taken 2 to 3 times a day to effectively control blood sugar levels throughout the day. However, such frequent dosing can be inconvenient for diabetes patients and might lead them to forget to take their medication on time. Additionally, patients often experience gastrointestinal discomfort, such as feeling full and bloated or increased bowel movements, especially during the first three to four weeks of taking the traditional formulation. Therefore, many doctors do not immediately prescribe the highest dose but gradually increase it from a low dose to reduce the severity of gastrointestinal side effects.

Many patients might not be aware that there is an extended-release version of Metformin. Its glucose-lowering effect is similar to the traditional formulation, but it only needs to be taken once a day, improving patient adherence to the medication. Furthermore, it has fewer gastrointestinal side effects. It is unfortunate to abandon Metformin solely due to gastrointestinal discomfort, as patients can discuss with their doctors about switching to the extended-release version. If some public healthcare institutions do not provide it, patients can purchase it with a prescription from their doctor.

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