Diabetes drug (Metformin) may reduce Covid risk

Image source: American Diabetes Association

You Could Be Protected Against Long Covid by an Old Diabetes Drug (Metformin)

Diabetes is a long-term (chronic) illness that affects how your body converts food into energy.

The majority of the food you consume is converted by your body into sugar (glucose), which is then released into your circulation. Your pancreas releases insulin when your blood sugar levels rise. In order for blood sugar to enter your body’s cells and be used as energy, insulin functions like a key. 

Diabetes Types 

Type 1 :  It is believed that an autoimmune response is what causes type 1 diabetes (the body attacks itself by mistake). Your body’s production of insulin is stopped by this response. Type 1 diabetes affects between 5–10% of those who have the disease. Type 1 diabetes symptoms may appear suddenly. Typically, it is discovered in kids, teenagers, and young adults. You must take insulin every day to stay alive if you have type 1 diabetes. There is currently no cure for type 1 diabetes.

Type 2 : Your body struggles to properly utilize insulin in type 2 diabetes, making it difficult to maintain normal blood sugar levels. The majority of diabetics (90–95%) are type 2. It takes years to develop, and adults are often diagnosed with it (but more and more in children, teens, and young adults). If you are at risk, it is crucial to have your blood sugar tested because you might not exhibit any symptoms. By adopting healthy lifestyle adjustments like these, type 2 diabetes can be avoided or postponed.

 – reducing weight.
 – eating a balanced diet.
 – being energetic.

Type 1 diabetes medications

Insulin

The most typical drug used to treat type 1 diabetes is insulin. In the US, more than 20 different varieties are offered. With the use of an insulin pump, it is administered intravenously or intramuscularly. There are several insulin varieties. They differ depending on whether they reach a peak level of activity, how fast they begin acting, and how long they work. Your body’s sensitivity to insulin and the degree of your insulin shortage determine the type of insulin you require. They consist of the following:

1. Short-acting Insulin : 30 minutes after injection, regular or “short-acting” insulin may enter the system and peak 2-3 hours later. These injections are effective for a further 3-6 hours. Types of regular insulin include: R U-100 Humulin
   Flex Pen R Novolin
   Novolin Reliability
   Flex Pen Reliance Novolin R
2. Rapid-acting Insulin : Rapid-acting insulin begins to function within 15 minutes, as the name implies. The drug has a peak effect between one and two hours after administration and lasts for two to four hours. Rapid-acting insulin comes in a variety of forms, including: Insulin glulisine (Apidra, Apidra SoloStar), which is only available as a brand-name medication, insulin lispro (Admelog, Admelog SoloStar, Humalog, Humalog KwikPen, Humalog Junior KwikPen), insulin aspart (Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog Flex (Lyumjev, Lyumjev KwikPen)

Metformin, a Diabetes drug, may prevent severe Covid.

Image source : Medical Express

The researchers found that a group of Diabetics who were taking metformin when they contracted the coronavirus had a 44% lower chance of dying from Covid. The results indicated that diabetics on metformin were 50% less likely to need ventilation while they fought off their Covid infection. Lead researcher Dr. Carolyn Bramante, an assistant professor of medicine at the University of Minnesota Medical School in Minneapolis, noted that these findings are consistent with past research including a clinical study that showed the preventive benefits of metformin against Covid.

According to Bramante, “all of this data suggests that metformin has a role in avoiding SARS-CoV-2 and severe Covid.” She highlighted that French lilacs were the source of metformin’s initial discovery in the early 1920s. “Some of the early publications on metformin that were published dealt with influenza and the prevention or association of metformin with less severe influenza. The 1940s and 1950s, according to Bramante.

In 1994, the U.S. Food and Drug Administration gave metformin its nod as a diabetic treatment. According to Johns Hopkins, the medication aids diabetics by lessening the liver’s capacity to release blood sugar from its reserves. This entire body of data indicates that there is a function in According to Bramante, researchers began studying metformin against additional viruses in the 2010s, including Zika and hepatitis C. However, metformin also appears to have antiviral and anti-inflammatory properties.

Researchers reasoned that this made metformin an obvious choice for use in treating Covid. According to research results published in August in the New England Journal of Medicine, metformin reduces the likelihood of emergency room visits, hospitalizations, or mortality owing to Covid in overweight or obese individuals by over 40%, and by over 50% if administered early in the beginning of symptoms.

Metformin lowers the risk of ER visits, hospitalizations, or fatality due to Covid in overweight or obese people by over 40%, and by over 50% if given early in the onset of symptoms, according to research findings published in August in the New England Journal of Medicine. The clinical trial’s principal investigator, Bramante, noted that the earlier metformin was begun, the better it prevented severe Covid. Therefore, they had the greatest impact in avoiding ER visits, hospitalisation, and mortality from Covid among those who started it in fewer than four days of symptoms.  Nevertheless, such findings were not regarded as definitive because metformin fell short of the clinical trial’s main objective, which was to stop participants from experiencing potentially fatal low blood oxygen levels as a result of their Covid. With this latest study, Bramante has extended her investigation of metformin, which included more than 6,600 type 2 diabetics who contracted Covid. 

The study group compared the outcomes of patients on metformin to those receiving other diabetes prescriptions. The researchers discovered that those receiving metformin had a decreased chance of mortality or ventilation compared to those taking a kind of diabetic medication called sulfonylureas.

According to Bramante, “there was around a 50% reduction in mortality and the requirement for a breathing tube.” “That is comparable to what we observed in the clinical study in terms of avoiding the requirement for hospitalisation or Covid related death. Additionally, it has been reported in other observational studies that have been published that the severity of those outcomes has decreased by 40% to 50%. According to Bramante, the antiviral activity of metformin is what protects patients since it has been demonstrated to stop the Covid virus from growing in a test tube. By suppressing a protein called MTOR, which the virus needs to assemble itself before generating a new set of viruses outside the cell, metformin, according to our theory, stops SARS-CoV-2 from replicating.

The National Foundation for Infectious Diseases’ medical director, Dr. William Schaffner, believes metformin may be effective in treating Covid. However, Schaffner believes that the Covid advantages mentioned in studies are likely explained by the drug’s anti-inflammatory properties. “Metformin has a very evident anti-inflammatory effect. There are some theories that it could have direct antiviral activity, although Schaffner believes it’s more of an anti-inflammatory reaction.

“Of course, after the virus has established itself, an inflammatory reaction occurs. And we now know that the inflammatory reaction, which results in collateral damage throughout the body, is what actually leads to serious illness. And if you could tame or lessen that inflammatory reaction, you might be able to defend yourself against more serious, dangerous diseases. Bramante believes that since metformin is already FDA-approved, physicians ought to look about using it off-label to assist high-risk Covid patients.

“There is unquestionably sufficient evidence to support a prescriber’s choice to utilize it. In my view, that would not be in issue,” Bramante added. We have a few more clinical trial papers coming out,” she said, adding that it will be crucial for guidelines committees to analyze the information at hand and decide whether or not to include metformin in treatment recommendations. If used, metformin would be a very secure and cost-effective Covid therapy, according to Bramante. She said that there aren’t many drug interactions with metformin, which is recommended for usage in both children and pregnant people. Gastrointestinal troubles are its most frequent adverse effect, and those usually go away if the dose is decreased. 

According to Bramante, the price of quick release metformin is less than $4 per month. However, Schaffner wants to see more proof before the medication is used to treat or prevent Covid. He stated, “I think we need confirmation studies and maybe prospective trials before we start providing huge populations a medicine. It is a big step, that’s a significant leap.

The action of metformin

In the 1950s, the diabetic medication metformin—now widely available—was employed as the antiviral “Fluamine.” A recent study from the University of Minnesota demonstrated that those who began exhibiting Covid symptoms and took this medication within the first four days did not need to go to the hospital or face a danger of dying from the virus. The medicine disrupts the mechanisms that cause inflammation, according to the research. For context, consider that Covid includes viral inflammation. Metformin is a biguanide antihyperglycemic that is used in combination with diet and exercise to regulate blood sugar levels in type 2 diabetes. It is also used off-label for insulin resistance in polycystic ovary syndrome (PCOS).

Metformin formulations with immediate release: Metformin is prescribed as an addition to diet and exercise to enhance glycemic control in adults and pediatric patients with type 2 diabetes mellitus over the age of 10 years.

What was the study’s purpose?

The research, which was released on Thursday in the New England Journal of Medicine, examined three drugs that were thought to be effective: metformin, ivermectin, which has received a lot of attention, and fluvoxamine, an antidepressant that has demonstrated effectiveness in prior trials.

The study team decided to test the medicine because they believed the anti-inflammatory and antiviral effects together were fascinating enough. “This was particularly exciting to us early on when we saw that patients using metformin were contracting Covid less frequently and being hospitalized less,” said Elaine Lissner, the executive director of the charity Parsemus Foundation in California. In order to get life-saving findings more rapidly, the trial recruited 1,323 individuals who were most at risk of adverse outcomes: persons over 30 and with a body mass index (BMI) over 25 kg/m2.

What did the research find?

The researchers found that metformin, a remarkably cheap medication, can reduce severe outcomes by more than half when given to high-risk individuals as soon as possible with Covid. “Millions of individuals worldwide use the medicine metformin, which is highly widespread. It is far simpler to take than the other two, there is no stigma as there is with an antidepressant, “Libner stated.

According to the FDA’s guidelines, metformin should not be administered to patients with severe renal disease and should only be taken with meals or in an extended-release version to prevent stomach distress. Loose stools are one of the mild side effects. The researchers also noted that metformin is regarded as safe for usage during pregnancy.

Metformin brand names

Because it effectively treats diabetes and is inexpensive, metformin “is a popular drug,”. All forms of metformin—aside from the recently authorized extended-release liquid—are accessible in generic form. Utilizing a generic type of metformin aids in reducing the cost of your prescriptions.

Some Brand names of Metformin : 

• Fortamet
• Glucophage
• Glucophage XR
• Glumetza
• Riomet
• Riomet ER (only available as brand name)

Typical Metformin Side Effects

In general, metformin is well tolerated. However, taking it might have negative effects, just like taking any medicine. Let’s start by examining the most frequent adverse effects.

Gastrointestinal (GI) Upset

“GI upset is the most frequent adverse reaction. Diarrhea is a frequent ailment. In actuality, diarrhoea is reported by more than 50% of metformin users. Other GI side effects than diarrhoea include:

 – Heartburn

 – Gas

 – Nausea

 – Abdominal pain

 – Vomiting

Additional typical side effects

Although GI discomfort is by far the most frequent adverse reaction, metformin can also result in:

 – Altered flavour, particularly one that is metallic

 – Weakness or exhaustion

 – Headache 

People using the immediate-release pill reported these adverse effects more frequently than those taking the extended-release one. Speak with your healthcare practitioner if these adverse effects become severe, grow worse, or don’t improve with time. If you aren’t already taking the extended-release pill, they could wish to switch.