Approaching Chemistry: what can I take instead of metformin?

Diabetes, a disease suffered by hundreds of millions of people in the world, usually relies on drugs to adjust blood sugar. The main drug used is metformin. What if I cannot take metformin due to physical reasons or the need to take other medications? What can I take instead of metformin? Come and study with me.

What is metformin?

Metformin is an anti-diabetes drug used by 150 million people, which can treat the high blood sugar level of type 2 diabetes patients. It reduces the absorption of glucose by the intestine, thereby reducing the production of glucose in the liver and increasing insulin sensitivity.

Using medications like metformin to control blood sugar levels can help avoid consequences like kidney damage. The risk of a heart attack or stroke can also be decreased with effective diabetes management.

Having been used in clinical settings for more than 60 years, metformin is the first-choice medication for the treatment of type 2 diabetes. Its outstanding hypoglycemic impact and strong safety profile have solidified its place in clinical practice. Metformin’s exceptional performance in areas other than hypoglycemia therapy, such as weight reduction, cardiovascular protection, decreasing blood lipids, anti-tumor therapy, and enhancing cognitive function, is primarily responsible for its prestigious reputation.

Its safety and tolerability and its hypoglycemic effectiveness are good. While learning contraindications, prolonged usage does not raise the risk of hyperlactatemia or lactic acidosis.

Furthermore, metformin protects the cardiovascular system through a variety of specific protective mechanisms, such as lowering body weight, controlling gut microbiota, controlling coagulation, lowering oxidative stress and inflammation, enhancing vascular endothelial function, and enhancing blood sugar levels, among other metabolic markers. It lowers the risk of cardiovascular disease and aids in blood sugar regulation.  

What can I take instead of metformin?

Although metformin is cheap and easy to use, it can cause strong side effects and may be harmful to some users, including chronic diarrhea, spasms, etc. In addition, these side effects may lead to eating disorders or interfere with their exercise. Sometimes, it is possible to take an irreplaceable drug that can have adverse interactions with metformin at the same time. Even worse, for some patients, metformin has no effect at all and can even lead to obesity. Based on the above considerations, it is necessary to search for alternative drugs for metformin.

The alternatives to metformin are listed in the following five categories.

The first type is insulin secretagogue, which stimulates the pancreatic islets β Cells secrete insulin to lower blood sugar. The advantages of such drugs include significant hypoglycemic effects and economic practicality. However, if diet and exercise are not coordinated properly, it can easily lead to hypoglycemia, and patients with renal insufficiency should be disabled.

The type of glinide drug is another choice. They are less likely to result in hypoglycemia and can rapidly drop blood sugar, but they need to be taken in many doses and misuse can cause hypoglycemia.

The third is α-Glycosidase inhibitors, which are mostly used to regulate blood sugar levels after meals. They may be taken in addition to other hypoglycemic medications. Postprandial blood sugar is significantly reduced, there are fewer adverse effects on the liver and kidneys, and hypoglycemia susceptibility is decreased. Nonetheless, gastrointestinal pain can occur in people with impaired stomach function.

Medication thiazolidinediones is the fourth category. An example of a representative medication is pioglitazone. They are less likely to result in hypoglycemia and are useful for treating people with metabolic syndrome and clear insulin resistance. However, when combined with other hypoglycemic medications, these medications may result in hypoglycemia and raise the risk of heart failure and fractures.

The SGLT-2 inhibitor is the final one that has drawn a lot of interest recently. These are a novel class of hypoglycemic oral medications. Some advantages of these medications include decreased hypoglycemia danger, blood pressure assistance, weight loss, and improved renal and cardiovascular protection. However，a typical adverse effect is that it can lead to infections of the reproductive and urinary systems, which is not suitable for patients with lean diabetes.

Conclusion

To sum up, what can I take instead of metformin? This article lists five pharmaceuticals that have the potential to replace metformin, each with pros and cons: SGLT-2 inhibitors, α-Glycosidase inhibitors, thiazolidinedione drugs, and insulin secretagogue. I hope that everyone will prioritize regular exercise and leading a healthy lifestyle.