Harvard Health Letter

Metformin: Now or later?

Losing weight is the ideal way to deal with type 2 diabetes, the most common form of the disease. Just shedding 10 pounds or so will usually bring blood sugar levels back into the normal, healthy range.

The problem is that while many people can remain diet-and-exercise virtuous long enough to lose a few pounds — even 10 or so — most of us can't stay that way. The lost weight has a way of finding its way back home around our middles.

The American Diabetes Association's guidelines acknowledge that people have trouble keeping weight off. "Lifestyle interventions" to lose weight and get more active are step one in its guidelines. But the association also says that new patients should start taking metformin (Glucophage) right away because interventions usually don't work over the long haul. Metformin lowers blood sugar levels by decreasing the liver's production of sugar and by increasing the effectiveness of insulin, the hormone that escorts sugar into cells. Insulin resistance is one of the main features of type 2 diabetes. Cells start rebuffing the hormone, so sugar has nowhere to go. Levels in the blood start to climb.

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