Over the past two days, users on social media have reported that metformin, which is used to treat diabetes, causes cancer. How true is this? What advice should be given to diabetics who use it, especially in light of the emerging epidemic of Corona virus "Covid-19 ″"?
Metformin is a drug taken to treat high blood sugar levels caused by type 2 diabetes, and it is available under various brand names, such as "Glucophage", "Glucophage XR", and Fortamet and Glumetza.
Metformin is used in conjunction with a healthy diet and proper physical activity program, and possibly with other medications to control high blood sugar.
By controlling high blood sugar, metformin helps reduce or prevent complications of diabetes, such as kidney damage, blindness, nerve problems, amputations, and sexual problems such as impotence, and proper control of diabetes also helps reduce the risk of a heart attack or stroke.
Metformin helps restore the body's response to the hormone insulin that the body produces naturally. It also reduces the amount of sugar produced by the liver and also absorbed by the intestine.
Metformin works by the following mechanisms:
1- Reducing the amount of glucose (sugar) that the liver makes.
2- Reducing the amount of glucose absorbed by the body.
3- Increasing the effect of insulin on cells in the body.
4- Helping to reduce appetite, which helps control a person’s intake of food and calories, which reflects positively on controlling blood sugar.
5- According to studies, metformin may help reduce weight in diabetics, of course while using it with a healthy diet and exercise program appropriate for a person’s health.
What is the origin of the story of metformin and cancer?
The US Food and Drug Administration said yesterday that it had recommended five drug manufacturers to withdraw metformin, after it discovered high levels of impurity that could cause cancer in some versions of this drug.
The administration indicated that these drugs contained potential carcinogenic impurity "N-nitrosodimethalamine", as they exceeded the permissible limits in the extended-acting formulations only.
Contamination with this impurity, "N-nitrosodimethalamine" was responsible for withdrawing the medicine, "Zantac", which is sold by Sanofi and some equivalent copies of this treatment last year.
The FDA - which has said it will publish withdrawal notices to companies on its website - named Canadian Abbotex as one of the companies that contain metformin tablets it produces at high levels of "N-nitrosodimethalamine" impurity, and has not yet revealed the names of the other four companies.
So is metformin carcinogenic?
Answer: No, the US Food and Drug Administration has never said that it is carcinogenic, but rather recommended that some of its products be withdrawn because they are contaminated with a possible carcinogenic impurity: "N-nitrosodimethalamine".
In fact, the administration confirmed that patients should continue to take metformin tablets even after withdrawal, and recommended them in consultation with their healthcare professionals so that they can prescribe an alternative.
Metformin may protect against cancer
In contrast, many studies have found a relationship between metformin use and a lower risk of various types of cancer, especially pancreatic, colon and liver cancer.
In 2018 a Qatari medical study found that metformin reduces the risk of cancer among diabetics, and the study was conducted by researchers from Weill Cornell Medicine - Qatar, and published in the scientific journal Cancer Treatment Reviews.
In 2016, American researchers at the University of Pennsylvania School of Medicine said that metformin has been shown to be effective in treating breast cancer, as it treats endometrial hyperplasia without side effects.
What advice for diabetics?
A diabetic patient should discuss the matter with his doctor. If he uses one of the products recommended by the American Food and Drug Administration to withdraw it, the doctor will write to him an alternative type of metformin, and he should take care of his health and take his medications, because diabetics - especially the elderly - may be more vulnerable to complications of Covid-19, Where a study published on Friday showed that people with type 2 diabetes who are over 75 years old and who suffer from complications related to their disease are more likely to suffer from the severe form of Covid-19.
It has been known until now that diabetes is one of the factors aggravating the emerging corona virus, and it is likely that the diabetic patient will suffer from a severe form of the epidemic and die as a result, just like people who are obese and have high blood pressure or the elderly.
But no study has yet identified the types of diabetics suffering from an acute form of Covid-19.
A study published in the journal "Diabetology" specialized medical information for 1317 diabetics suffering from severe form of Covid-19 and were hospitalized in France between 10 and 31 March last.
"Diabetics were classified as people at risk (...) as those with type 2 diabetes in the elderly and patients with type 1 diabetes among young adults who were 30 years old and dependent on insulin," endocrinologist Bertrand Carreux - who participated in this work - told the French news agency. ".
The diabetics most susceptible to infection with the new coronavirus are elderly people and people with type 2 diabetes, which is the most common form of the disease, in addition to those who are overweight.
The study also showed that there were very few Type 1 diabetes patients among those who suffered from an acute form of Covid-19 (only 3% of cases).
When looking for factors that increase the risk of death, it appears in the first place age, as people with diabetes who are more than 75 years old are more likely to die after seven days in hospital than those under 55 years of age.
People with complications related to diabetes are more likely to die with Covid-19.