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If I Had - Diabetes - Dr. David M. Nathan, MD, Massachusetts General Hospital; Harvard Medical School
If I Had - Diabetes - Dr. David M. Nathan, MD, Massachusetts General Hospital; Harvard Medical School

(November 19, 2008 - Insidermedicine) On a recent trip to Boston, we caught up with Dr. David Nathan, MD, who is the Director of both the General Clinical Research Center and the Diabetes Center at Massachusetts General Hospital, as well as a Professor of Medicine at Harvard Medical School.  Dr. Nathan is also the Chairman of the Diabetes Prevention Program, an NIH-sponsored multicenter trial to prevent type 2 diabetes.

If I had diabetes…

If I had diabetes and had just visited my doctor’s office and had a blood sugar tested, and the doctor said “your level last year was a little bit high, and now it has gone over the level where it is considered diabetic”, what would I do? What should you do?  I think the answer is pretty straightforward. For most people with type 2 diabetes, this is the epidemic form of diabetes which is occurring at a rate of about one and a half million new cases per year in the United States alone, most of it is associated with being overweight and sedentary, and being somewhat older, so people for the most part are developing this diabetes in their 40s, 50s and 60s. We’ve discovered that one of the ways, in fact maybe the most effective way of  reversing the diabetes early on, or even preventing it in the first place, is to get people off of their backsides and get them to be more active and to try to lose weight. Now the amount of weight that they need to lose is not enormous, it is not as though you need to lose enough to get back to where you were in high school, but something like a 10lb weight loss, on average, is going to either be able to prevent the diabetes from developing or can actually reverse it in its early stages. However, since lifestyle intervention, as we call it, is generally not as effective as we would like it to be (the evidence for that is obviously that everybody is getting to be overweight, and everybody is getting diabetes), we are actually recommending that people start a medication for diabetes very very early, from the day that they are diagnosed.

So if you came across the street and knocked on my door and said “I have diabetes, what should I do?” I would say that firstly you should really work hard to get your weight down and increase your activity levels, I would then have you make sure that you see your doctor again and ask your doctor whether in fact you shouldn’t be started on the drug called Metformin, this is a very old drug that has been used for years, and is probably the most commonly used drug on the face of the planet, it’s inexpensive, it is relatively well tolerated, has very few side effects, and for most people that is what we are recommending on day one, when they develop their diabetes.

What does Metformin do?

Metformin is a very old drug, it was discovered more than 40 years ago, and what it does is it decreases the amount of sugar that your liver makes. So the amount of sugar that is put out by the liver, which contributes to your overall glucose levels (sugar levels), is inhibited or decreased by the Metformin and that is how it lowers blood sugar levels.