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Medical Author:

Ruchi Mathur, MD, FRCP(C)

Ruchi Mathur, MD, FRCP(C)

Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Metformin (Glucophage) is a medication used to treat diabetes. It has two mechanisms of action that help to control blood glucose levels. It prevents the liver from releasing glucose into the blood, and it increases the sensitivity of muscle and fat cells to insulin so that they remove more glucose from the blood. Because of these actions, metformin effectively reduces blood insulin levels. Metformin is a reasonably safe medication when used as indicated. Although there are gastrointestinal side effects with metformin, the drug usually is well-tolerated.

Interestingly, a study known as the DPP study evaluated at the effects of metformin in addition to diet and exercise on the prevention of diabetes in insulin resistance. Metformin reduced the development of diabetes by 31%.

Acarbose (Precose) is another medication that can be used for treatment of insulin resistance. It works in the intestines to slow the absorption of sugars, and this effect can reduce the need for insulin after meals. The Study to Prevent Non-insulin Dependent Diabetes Mellitus trial (also known as the STOP NIDDM Trial), treated individuals with insulin resistance with acarbose and found that that acarbose reduced the development of diabetes by 25%.

Other medications in a class of drugs called thiazolidinediones, for example, pioglitazone (Actos), rosiglitazone (Avandia), also increase sensitivity to insulin. At this time, however, these medications are not routinely used, in part because of liver toxicity that requires monitoring of blood liver tests. Avandia, however, has been associated with an increased risk of heart attack and stroke, and experts have debated the severity of these concerns since the risk was first reported. On September 23, 2010, the U.S. Food and Drug Administration (FDA) announced that it will significantly restrict the use of the diabetes drug rosiglitazone (Avandia) to patients with type 2 diabetes who cannot control their diabetes on other medications such as pioglitazone (Actos). These new restrictions are in response to data that suggest an elevated risk of cardiovascular events, such as heart attack and stroke, in patients treated with Avandia.

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